When clients first get in touch to explore their problematic porn use, one of the first things they ask is, “Am I only allowed to talk about my porn use?” This is often the starting point for understanding that, for many clients who struggle with this issue, it is not necessarily the porn use itself that is the key problem, but a range of underlying thoughts, beliefs, and experiences driving the need to self-soothe through this behaviour.

There can sometimes be an assumption that, when working in this area, much of the work will focus around behavioural techniques; trying to create distance between the client and their behaviour. While this is undoubtedly an important part of the work, a large portion revolves around exploring areas that are seemingly “unrelated” to porn use. This can include negative core beliefs, difficulties maintaining relationships, finding meaning and purpose in life, and the client’s relationship with their family of origin.

On numerous occasions, clients will say, “I know this isn’t related to my porn use, but…”, and I often have to remind them that all of it is relevant. Below, I’ve highlighted some of the key areas that tend to come up when I’m working with this client group.

Relationships are important

Understanding how clients relate to those around them is a key starting point for me. Getting an idea of where they feel most comfortable in themselves, who they feel safe with, and who they can turn to for support is important. For many of the clients I work with, there are often attachment issues that stem from early childhood, with recurring patterns mirrored in current relationships. Understanding how these relationships impact the client’s sense of self is essential. As always, the development of a healthy working alliance within the therapeutic relationship creates the foundation for clients to feel safe enough to share their internal world with the therapist.

Identifying and regulating emotions

Developing better self-awareness and understanding how clients’ emotional states influence their behaviour is a vital component of this work. Encouraging clients to reflect on their emotional states helps them identify key areas where they are likely to need to self-soothe. Once these have been identified, exploring healthy ways to manage and regulate these emotional states becomes key to the development of the work. This process is collaborative rather than prescriptive, as each individual will have different levels of tolerance and different emotional needs.

Self-awareness and reflective functioning

This expands on the previous point about identifying and regulating emotions, but exploring clients’ self-awareness and ability to reflect effectively on both their own states of mind and the states of mind of others is important. We can often run on autopilot, falling back into the same old patterns of behaviour and into traps reinforced by negative core beliefs. Developing self-awareness and the ability to reflect allows clients to pause, check in with themselves, and recognise when they may be repeating the same patterns they are trying to avoid. This comes with time, patience, and practice, but over time begins to chip away at the embedded cycles that perpetuate addiction.

Working with core shame

Exploring the role shame plays in driving this behaviour, and its role within the addictive cycle, is possibly the most important element of this work. Clients often carry overwhelming shame about their relationship with pornography, and it is a behaviour that frequently lurks in the shadows, shrouded in secrecy and deception. Coming to therapy to try and get to grips with porn use is often the first step towards self-acceptance.

Working to understand the deeper roots of shame and its role in driving behaviour is incredibly important. Often, shame is the primary factor reinforcing the continuation of the addictive cycle and strengthening negative core beliefs. Working in this area can be challenging, particularly for clients who have been using these behaviours to manage emotional distress for a long time. Stripping away a client’s main coping mechanism and encouraging them to explore shame can require a great deal of patience, kindness and  compassion.

Developing a healthy sexual relationship with the self

Many clients feel caught in a kind of time capsule of sexual development, feeling trapped by their struggle to build healthy sexual relationships with others. Key to managing this is helping clients develop a healthier sexual relationship with themselves. This involves working with clients to understand what their sexuality means to them and how they can explore it in ways that feel safe and do not feed into the cycle of shame.

Acknowledging that healthy sexuality varies from person to person, we need to be mindful not to project our own views and values onto the client. Instead, we should remain open, curious, and willing to explore what feels safe and workable for them.

This work is hard and progress is not linear

While some clients can integrate these changes into their lives with relative ease, many will slip along the way. This is why developing greater self-compassion and understanding is so important in the early stages of the work. Shame is a profound emotion that can, at times, feel unbearable and can often reinforce the need to act out.

Managing expectations and setting achievable goals is important in helping clients continue the work and maintain perspective when they inevitably struggle. For many clients, porn use has become deeply embedded within their routines and has served as a vital source of soothing. Acknowledging that managing this problem takes time, patience, and kindness can help clients find approaches that genuinely work for them.

Overall, this work can be complex and nuanced, but in my experience it is also particularly rewarding. Although progress and development often come in different forms, many of the clients I work with are able to better understand themselves and develop a healthier relationship with both themselves and their sexuality.