Clinical Issues in Online
Sexual Activity: An Introduction||
The Internet has revolutionized our lives. For
many, the computer has become the primary source of entertainment and most
constant companion, often replacing other familiar media (TV, radio) and
face-to-face interaction (Lillie, 2002). Sexual topics are the most searched
for topics on the Internet (Cooper, Scherer Boies & Gordan, 1999), and up to
one-third of Internet users access some type of sexual content online (Cooper,
Delmonico & Burg, 2000). Authors like Cooper, Boies, Maheu, & Greenfield (1999)
suggest that the impact of the Internet on sexuality has been so profound that
cybersex may be fueling a new sexual revolution.
The Internet is unprecedented in its ability to
allow some forms of physical and emotional fulfillment to occur with a distant
or mostly unknown partner in a way that has been limited in the past. The
Internet has become a marketplace for finding partners who share our sexual
fantasies in a way that is “unmatched in its scope, unlimited by geography,
time, or numbers” (Ross, 2005, p. 344). This medium also offers the user the
opportunity to experiment with sexual behaviors that might be difficult to do in
real-time, either because partners are unavailable, or the individual is limited
by his or her self-consciousness. The Internet, then, offers a venue to
experiment with behavior with another person without actually “doing it” (Ross,
Online Sexual Activity: A Variety of Sexual
To begin a meaningful discussion of the uses and
implications of Online Sexual Activity (OSA), one must first understand the
range and nature of sexually-related activities available through the computer.
These behaviors may include viewing pictures (pornography/erotica), chatting
with others about sex in chatrooms, sending or receiving sexually explicit
e-mails, sharing fantasies, or participating in real-time cybersex in chatrooms,
using the chatrooms as either starting places for offline relationships or
online sex without any pursuit of off-line, “real”, contacts with partners (see
Griffiths, 2001, for an extensive list of Internet sexual behaviors).
Among those who report use of or preference for on-line pornography,
the most commonly cited reasons for preferring this venue are ease of Internet
use, ease of access for those who are shy, lonely, or have limited social
skills, anonymity and the attendant sense of safety to experiment on-line,
ability to avoid interpersonal contact, and ability to control visuals and the
overall environment (Ross, Rosser, McCurdy & Feldman, 2007).
Studies of online sexual behavior consistently
reveal gender differences. Population studies have suggested that the use of
Internet pornography is a predominantly male phenomenon, with 25% of American
males reporting use of Internet pornography compared to 4% of females (Buzzell,
2005). Gay-identified men may be up to four times more likely to use OSA than
straight-identified men, and OSA may play an important role for some in the
coming out process. More men than women report that online sexual behavior
has become problematic for them, though women are overrepresented among
problematic users (Cooper et al, 2004; Ferree, 2003).
Women appear to seek online sexual activities that
involve a romantic or relational component, and women strongly prefer chatrooms
that allow relational experiences with others over solitary activities like
viewing pornography (Ferree, 2003). Women are also more likely than men to
pursue real-life meetings with those that they meet on-line (Ferree, 2003;
Schneider, 2000). In contrast, men appear to be more interested in solitary
online pursuits, usually visual activities (Ferree, 2003). According to Ferree
(2003), women may also be more likely to use free sexual materials, while men
are more likely to pay for sexual images.
Cyberporn, Personality Characteristics, and Mental
Health: Mostly Good News
Many clinicians have been concerned about possible
relationships between OSA and sexual aggression or violence against partners.
Some research suggests that egalitarian attitudes towards women have been
positively related with viewing sexually explicit movies or videos (Fisher &
Barak, 2001). Barak et al (1999) found no relationship between self-regulated
exposure to sexually explicit Internet sites and later measures of rape myth
acceptance or negative attitudes towards women. Ybarra and Mitchell (2005) also
found no relationship between pornography exposure, even at very frequent
levels, and sexual aggression. However, a study by Burns (2001) suggested that
men who are frequently exposed to Internet pornography were more likely to
describe women in sexual terms, and embrace stereotypically feminine gender
roles, while also perceiving women positively.
Cooper et al (2004) define Online Sexual
Compulsivity as a condition that exists when ongoing use of online sexual
activity interferes with occupational, social, or recreational functioning.
Those who experience such problems often report the inability to manage or stop
the activity or to reduce the impact of these activities on overall
functioning. OSA is believed by some to be more addictive than other,
traditional forms of pornography (e.g. print, films) due to the Triple-A Engine
(Cooper & Sportolari, 1997): the Accessibility, Anonymity, and Affordability of
sexually explicit Internet material.
Cooper, Scherer, Boies, & Gordon (1999) concluded
that the majority of individuals who used the Internet for sexual purposes did
not show measurable concerns or problems, but for a smaller percentage (about
8%) of users, cybersex posed significant problems (Cooper, Delmonico,
Griffin-Shelley & Mathy, 2004). Cooper et al (1999) suggested three categories
of cybersex users: recreational, sexually compulsive, and at-risk. Among
at-risk users, they identified two subtypes: those who use Internet materials
most during times of high stress, and those who seek relief from depression or
other emotional difficulties by accessing online sexual materials. According to
Cooper et al (2004), no single behavior accurately predicts whether an
individual will become compulsive in his or her use of online sexual materials.
Studies exploring comorbidity of problematic OSA
with other types of distress have shown relationships between problematic OSA
and other forms of sexual addiction, mood and anxiety disorders, past history of
sexual abuse, chemical dependency (men) and eating disorders (women) (Schneider,
2000, Schwartz & Southern, 2000). For some individuals the computer offers a
new venue for the expression of an existing disorder, while for others the
access to sexual material on the Internet appears to rapidly produce new and
Individuals may experience relational, occupational, legal,
financial, and personal distress as a result of OSA. These problems may result
from one-time use or from ongoing use of sexually explicit materials. Common
consequences of compulsive Internet sexual behavior include client reports of
depression, social isolation, worsening of the sexual relationship with a spouse
or partner, damage done to the marriage or primary relationship, exposure of
children to masturbation or sexually explicit materials, impaired job
performance or job loss, financial losses and legal consequences (Schneider,
First, as with other concerns that our clients bring
to us, we must begin by assessing the nature and the scope of the difficulty the
client is having with OSA. As previously mentioned, most use of OSA is
non-problematic, and wise clinicians avoid overreaction to reports of OSA while
focusing on the behaviors that are causing problems. Two helpful tools in
assessment are Delmonico’s Internet Sex Screening Test (www.sexhelp.com/isst.cfm)
and Weiss’s CyberSex Addiction Checklist (http://sash.net).
If one is not already doing so, adding assessment of computer use to one’s
intake is a good first step, as it allows one to assess total time spent on the
computer for academic and recreational tasks and both problematic and adaptive
uses of the computer. This type of exploration can also help identify
additional problems the student/client may be having with online gambling or
gaming (such as the Massive Multiplayer Online Games, e.g. World of Warcraft and
similar games) or excessive time spent in social networking sites such a MySpace
Client and therapist may also find it helpful to
identify motivators and reinforcers for problematic OSA, including both physical
motivators like excitement/arousal, comfort (tension reduction), and escape
(trance, mood regulation) and psychological motivators like affirmation,
overcoming feelings of helplessness or powerlessness, and the desires for power
and revenge. It is also helpful with many clients to discuss the ways in which
problematic OSA has led to negative consequences in the following areas:
relationships, occupational problems, legal problems, financial problems,
emotional distress, religious/spiritual problems and medical conditions.
Because many clients feel premature comfort and familiarity with partners met
on-line and may not take precautions when having sexual contact with them, the
therapist may also want to encourage the client to pursue STD/STI testing.
Treatment may include both inpatient and outpatient interventions.
Because the majority of those who seek treatment for addiction to online sex
also have more pervasive sexual and chemical addictions, depression, and other
disorders, inpatient treatment may be particularly effective with many addicts (Orzack
& Ross, 2000). Outpatient treatment, such as what we offer in college and
university counseling centers, may include individual, couples, and group
psychotherapy, as well as participation in 12-step and similar peer-support
Once treatment begins, several strategies may be helpful:
Negotiate a specific treatment plan
that includes incremental goals and reasonable expectations.
Impose time limits on cybersex and
other computer use. For most students, complete abstinence from all online
activities is unfeasible, but the student may find it helpful to create a
schedule of computer use and types of online activities that s/he finds
Enlist the help of an accountability
partner (preferably not one’s romantic/sexual partner) in maintaining
Purchase and install blocking software
or sign up for an internet service provider than includes this feature.
Limit computer use to public spaces
(e.g. move computers with internet access into common living or study areas).
Learn mindfulness techniques to
increase awareness of sexual behaviors and feelings, both while on-line and
Reduce anonymity while online by using
one’s real name and real contact information in online interactions.
Reduce objectification of others
encountered online by imagining realistic scenarios (e.g. in addition to
appearing naked on the screen, the person being viewed is also someone’s child,
a student, etc.).
Increase overall support by helping
clients connect to supportive peer networks.
Encourage the use of rewards and
consequences (e.g. a reward for each day of OSA-free computer use, sending money
to charity each time the person engages in OSA).
Help the client identify coping
strategies that don’t involve OSA for use when bored, angry, anxious, lonely,
and tired (e.g. exercise).
Help the client grieve the loss of
cybersex and the important needs that it addressed.
Help the client grieve the
relationship, occupational, legal, financial, medical, other losses associated
with OSA use.
Help the client identify ways to use
the internet that support the client’s needs while reducing the risk of
encountering OSA-related problems (e.g. increasing social, non-sexual contact
with others in social networking sites may be a good first step as the client
moves away from contact with others in OSA).
While many individuals do not report negative emotional or
relational consequences from the use of OSA, a portion of those who use
internet pornography and other online sexual materials do so compulsively and
experience painful disruptions across multiple areas of functioning.
Fortunately, effective treatments strategies are available for clients motivated
to reduce or eliminate OSA use.
Helpful Websites for Clinicians and Clients
Online Support Groups
Sex Addicts Anonymous
www.sa.org: Sexaholics Anonymous
www.sca-recovery.org: Sexual Compulsives Anonymous
www.recovering-couples.org: Recovering Couples
www.slaafws.org: Sex and Love Addicts Anonymous
www.sexualrecovery.org: Sexual Recovery Anonymous
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