In the long, self-lacerating statement that he read to a nationwide audience last week, Tiger Woods never used the words sex addiction. Yet by publicly apologizing for his infidelity, saying he was returning to his religious faith and admitting that he has “work to do,” he appeared to be carrying out several steps of a common 12-step treatment for just that.
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Experts in the field note that Woods hit several key points in the program used by the Gentle Path clinic in Hattiesburg, Miss., at whose front door he has been photographed.
In Steps 8 and 9 of the program, for instance, patients are admonished to list everyone they have harmed and make amends. In his statement, Woods dwelled on his mistakes and apologized to his family, his wife’s family, his business partners and sponsors, and parents who “used to point to me as a role model for their kids.”
In his seeming embrace of the 12-step approach — first formulated by Alcoholics Anonymous but since adopted by Narcotics Anonymous, Sex Addicts Anonymous and groups for gambling, food and shopping addictions — Woods waded into a longstanding debate over sexual disorders and how to treat them.
The very idea that someone can be addicted to sex is controversial and inevitably leads to chuckles and jokes. Those claiming addiction may be accused of seeking a medical excuse for simple promiscuity.
But while sex addiction is not recognized by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, psychiatrists have long recognized that there are “clear cases in which people ruin their lives because of sex,” said Dr. Michael First, a Columbia University psychiatry professor who edited the manual. “Hypersexual disorder” is now under consideration for the next edition.
“The question,” Dr. First said, “is how you draw the boundary between a healthy sexual appetite and addiction.”
Diagnosis depends on how much pursuing sex interferes with other goals, on whether the patient has tried to stop and failed, and on what mood the activity brings on.
For example, said Dr. Richard B. Krueger, a Columbia University psychiatrist specializing in the treatment of sex offenders, “a couple in love, floating five feet off the ground, having frequent sex” is different from a patient unable to stop watching pornography at work.
Treatment “is in its infancy,” Dr. Krueger said. “Chemical castration” with testosterone blockers, as has been used on some pedophiles, is inappropriate in such cases. Antidepressants suppress sex drive, erections or orgasm in some patients, but not all. Individual psychotherapy helps some addicts; 12-step programs help others.
At Gentle Path, patients live in a semicircle of cottages. Its founder, Patrick Carnes, declined to be interviewed but suggested therapists who knew its program.
Bart Mandell, a New York sex-addiction therapist and chairman emeritus of the International Institute for Trauma and Addiction Professionals, who trained at Gentle Path, said Woods’s daily schedule presumably included morning meditation and exercise — including obstacle courses to build trust with other patients and eye movement exercises to “get through his defenses.”
It would also have included interviews probing for childhood trauma or abandonment, several daily rounds of group therapy, art therapy — in which he would draw stories about himself — and “a tremendous amount of writing his sexual history,” including his first memories of sexual arousal and his first encounter with pornography, all the way up through the present. Mavis Humes Baird, another therapist familiar with Gentle Path, said Woods would have been separated from family contact for weeks and forbidden masturbation, pornography, contact with female fans or anything else that might engage his sex drive.
“You can’t have sex with yourself or anyone else,” Ms. Baird said.
In group meetings, addicts describe how their habits hurt their families, friends and careers and recount their lies, subterfuges and attempts to blame others.
Woods appeared to do that in his speech, emphasizing that his wife, Elin, “deserves praise, not blame.”
In role play, others may have played him, his wife, or even his public image, Ms. Baird said.
And while the therapy does not require public apologies, avoiding one would have been hard for someone like Woods, who has millions of fans he cannot reach in person. An apology with family in the room added to its power, because the point is less the apology than the resolution to change. “Or how is it different from the ‘I’m sorry, I’m sorry’ they’ve already heard?” Ms. Baird said.
Woods virtually echoed that: “As Elin pointed out to me, my real apology to her will come not in the form of words; it will come from my behavior over time.” His statement also touched on other aspects of typical 12-step programs. The first step is to admit powerlessness and acknowledge that one’s life is unmanageable. The third is to turn one’s life over “to the care of God as we understood God.”
Woods said he would turn to the Buddhist faith in which his mother raised him, and would immediately go back to therapy.
A 13-year member of Sex Addicts Anonymous who gave only his first name, Richard, said he admired Woods’s courage, saying he had outdone John Edwards, Bill Clinton and David Duchovny, all public figures whose careers were hurt by sex scandals, but who gave only what Richard considered vague admissions that they had trouble controlling their sex drives.
He himself had multiple affairs for 40 years, he said, and was stopped only when his second wife caught on.
Pursuing sex controlled his life, he said, and while he despised all the lies he told, the real drive was that he sought intimacy, enjoyed the hunt and liked being in control of vulnerable women.
“I enjoyed the feeling of powerfulness, the ability I had to attract people,” he said. “The sex had absolutely nothing to do with it. It was a sad situation.”
Mr. Mandell, who said he had treated professional sports figures and business executives, thought Woods sounded sincere. Recognizing that cynics would say Woods sought therapy only because he didn’t want to be divorced, Mr. Mandell said:
“Nobody goes through sex addiction therapy singing ‘Jingle Bells.’ Everybody hits bottom in one way or another. I’d say 80 percent get caught. Some do bluff their way through, but most people I deal with are motivated, or get motivated in treatment.”
