Licensed marriage and family therapist Jill Vermeire was on hand during the filming of Sex Rehab with Dr. Drew, bringing her clinical expertise to the world of reality TV. She’s agreed to lend us her perspective on the show’s shoot, as well as the rehabilitation of the cast. Below, Jill talks about the show’s fourth episode: withdrawal, the amount of time the patients are asked to refrain from masturbation, Kari Ann’s “disrespectful” (according to Phil) wardrobe, and art therapy.
The episode opens on the patients struggling with withdrawal. Can you talk about how the concept of withdrawal pertains to sex addiction versus drug addiction?
Sex addiction is a behavior addiction, as opposed to a chemical addiction. With drugs and alcohol, you’re going to see the withdrawal pretty quickly after you remove the drug because the body is chemically and physically dependent on it. With sex addiction, when you remove the drug–whether it’s masturbation, pornography, acting out with other people–it’s not as immediate of an effect, because the brain chemistry isn’t addicted to the chemicals, it’s addicted to the behavior and the emotional and psychological components of it. It takes a little bit longer for withdrawal to set in. Patients can still exist for a while just on what we call “euphoric recall,” and the high of their last acting out, which does produce the chemical oxytocin in the brain. The effects of oxytocin and dopamine and serotonin start to wear off days to weeks after the last major release when they’re related to the addiction. You’re not going to see the withdrawal effects until at least a week after the last acting out or hit.
Besides the fact that they’re talking about it a lot and that you can note the jitteriness of their behavior, how can you be sure that the patients are not masturbating?
The truth is that we can’t. It’s based really on an honor system, and how committed they are to their recovery. Just like in real life with my real life patients every day in my practice, I check in with them at the beginning of every session about their time sober. It’s really up to them and how much integrity they want to bring to their recovery as to whether they’re honest about what they’ve done. If you create am environment where it’s not shaming, and if they’re able to start to trust you and trust the process, they’re going to be more willing and more likely to be honest and forthcoming with their behaviors and whether they’ve acted out. We also had the night lights in their rooms, so if one of the producers or night people had seen something, we would have heard about it.
I know it probably varies from person to person, but how long do you usually tell them to refrain from masturbating?
What’s the philosophy there?
It’s just a good number. It’s one month, it gets them into their withdrawal, and then you get to start to see what the feelings are underneath the acting out. If chronic masturbation is part of their sex addiction, then it means they’re using it to numb out, check out and avoid feelings. They’re using it to deal with uncomfortable feelings or things they can’t tolerate. When you take away the coping mechanism, you’re going to see what it is they’re trying to medicate. There are plenty of people who can masturbate in a healthy way, and I have plenty of patients who don’t masturbate at all. I have plenty of patients who have acted out sexually, but have never touched themselves. They think that their private parts are gross, you know? This is a spectrum disorder. It’s not black and white, and nobody falls into one specific category. You really have to decide on an individual, case-by-case basis what is included in their addiction, and what needs to be eliminated for a while so you can allow the underlying feelings and issues to come up. It’s the same thing as removing cocaine, alcohol, or any other drug: if you allow them to keep using the drug, you’re never going to see what’s really going on underneath it. It’s not until you take away that coping mechanism that you really see what the underlying issues are.
Do you have any thoughts on Kendra refusing to participate in group because Kari-Ann was there?
Kendra had shut down at this point. I really think what was going on was that she grew up in a very chaotic environment. Her mother was very unstable, and I think Kari-Ann really brought up a lot of that for her. I think Kari-Ann really represented specifically her mother, but probably some other women in her life that were unstable and not safe. And Kendra learned to deal with it growing up by shutting off the feelings, shutting down and putting up the wall and becoming very guarded. Through this, we got to see how Kendra dealt with it in her past, and how she currently deals with it. That’s the awesome thing about the group treatment process: when you have a lot of people, each individual person will remind somebody of something else in their life, or someone else from their life. So it’s going to trigger old behaviors and defense mechanisms and survival techniques. And then we get to really see what happens out in the world for this person.
Phil also is affected by Kari Ann, specifically her wardrobe choices. He calls them “disrespectful.” Do you agree?
That was Kari Ann finding any way she can to act out. Women, especially female sex addicts, use clothing as part of their acting out behavior. I became the fashion police. On a daily basis, several times a day, I was having some of the women go back and change, or hike up their pants, or cover up. And some of the women, Amber for example, really honestly don’t understand how provocative their clothing is. There were time when I would ask Amber to cover up, and she would look at me in bewilderment: “What? This is revealing?” It was like relearning how to be a woman of grace and integrity, which is a term I use with all of my clients. This doesn’t mean that you have to wear a potato sack. It doesn’t mean you have to be mummified. You want to dress in a way that you feel great about yourself, but you’re not getting a hit. They can have attractive and sexy outfits that flatter their bodies and speak to who they are and their personalities, but Kari-Ann is a great, great, great example of using her clothing to get a hit. Whether she identifies that or not, or has the insight or not, she was finding ways, since we took away a lot of her “drugs”–her sex toys, her masturbation, sex with men, and seduction–that was her way of still being able to feel high. And it was really frustrating, and it was something that I commend the boys for being so tolerant of. Phil got very, very upset because it was right there in his face, and he was in withdrawal so he was extremely agitated because he was so uncomfortable. His skin was crawling. It was almost like having a cocaine addict in withdrawal, and having a pile of cocaine sitting in front of them.
Any thoughts on the art therapy?
The art therapy was amazing for some of the patients, because it really helped them get a lot of their feelings out in a form other than talking. One of the defense mechanisms that a lot of people will develop is that they will shut down verbally. They’ll almost go into a pre-verbal state of mind when confronted with their trauma, which means they actually shut down to the point where they really can’t find the words. Especially if the trauma happened to them early in childhood, they’ll resort back to that developmental age they were at in their brain, because that’s where that trauma is stuck, in that developmental part of their brain. If someone has that kind of experience, art therapy can be amazing. I’ve seen amazing results from people who aren’t responding to just talk therapy. You give them some crayons, you give them some paints, you give them clay, and they’re able to really show you through their art what is going on for them, and the feelings that they couldn’t find the words for. So, I was thrilled with the art therapy. We had some amazing experiences with some of the patients. Phil had a really cathartic experience. Duncan had a great experience. [So did] Nicole. Kendra completely shut down, because it brought up the violence from her past, which she couldn’t tolerate. You almost see her go into a very small child-like state of mind. I get chills just talking about it, because it’s so moving. You don’t see Kendra who she is now — you see this little girl show up. It’s this terrified child, who has all of this violence going on around her, and just covering her face, and almost going to curl up into a fetal position. It’s really moving.
Check out some screen shots from the episode in the gallery below: