Home Book Reviews Sex Addiction As Affect Dysregulation: A Neurobiologically Informed Holistic Treatment

Sex Addiction As Affect Dysregulation: A Neurobiologically Informed Holistic Treatment


Reviewed by Lucero Smith

Alexandra Katehakis’ book dives into the foundations of sex addiction and the best possible treatment of it through a neurobiological lense. Informed by her own experiences and therapeutic journey as well as her work as a psychotherapist, Katehakis offers her own conception of an approach to treatment called Psychobiological Approach to Sex Addiction Treatment (PASAT). PASAT combines “cognitive-behavioral containment of addiction, transpersonal psychology expanding the self beyond the individual, and emotionally regulating, intuitive, and relation-based psychotherapy informed by affective neuroscience” (4). The target audience is mainly psychotherapists as the book hones in on PASAT and how to utilize it, but it can also be appreciated by those dealing with sex addiction, whether they’re in recovery or not. Through Katehakis’ detailed examination of sex addiction as a legitimate disorder and her resulting treatment plan, it is clear that she is deeply passionate and knowledgeable about the subject.

The book opens with a foreword by Allan N. Schore followed by Katehakis’s introduction where she touches on her journey to becoming a psychotherapist and provides an overview of the book. She describes a deeply traumatic experience of her own that drew me in. My attention was captured by her explanation of her personal connection to psychotherapy; it humanizes her and serves as a way to broach the topic of psychotherapeutic treatment.

Katehakis’ approach incorporates three distinct components: cognitive-behavioral 12-step programs, transpersonal psychology, and relation-based psychotherapy based on affective neuroscience. Katehakis argues that her holistic approach provides sex addicts (SA’s) with the best possible treatment, not just to achieve sobriety but also to have a healthy relationship with sex. “For once addictive sexual behaviors have been arrested, the work of repairing and supporting neurological structures through human relatedness must begin…” (4). This is an important aspect of her approach as it provides the crucial missing piece to most cognitive-behavioral heavy addiction treatment methods that she critiques.

The book: Part 1, comprised of Chapters 1-4, explores SA. Chapter 1 summarizes the history of SA and demonstrates the connection between SA and affect regulation theory. Chapter 2 continues the discussion by looking into the neurobiological foundations of SA and how self-regulation development from infancy shapes these. The rest of Part 1 gives a contemporary, neurobiological definition of SA and examines the “individual, familial, and cultural forces” that contribute to the experiences of SA’s. Part 2, Chapters 5-10, advises psychotherapists on how to accurately evaluate SA and treat it utilizing the PASAT. It provides detailed procedures for connecting with patients by engaging both the left and right brain, getting them into a 12-step program, and integrating PASAT with the recovery program. Chapters 9 and 10, respectively, share patient outcomes and offer criticism of society’s relationship with sex as well as suggestions for improvement.

The natural flow and organization of the book make it far more comprehensible than the cover suggests. Though the title is somewhat intimidating, making Katehakis book seem heavily scientific, it is actually clearly written and user-friendly. There are mentions of neuroscience throughout, but they are seamlessly woven into the content. By dividing each chapter into sections and subsections, Katehakis breaks up her writing into manageable, cohesive portions. Visual graphs and illustrations, annotated transcriptions of her own sessions with patients, and even full stories, like the one she tells in Chapter 4, make this somewhat lengthy book (386 pages in all) more dynamic. These features also bolster her argument for her innovative treatment. Katehakis’ original, wide-scoped approach to SA treatment combines various theories and practices to develop a comprehensive method. The book itself does a good job of presenting PASAT by introducing it, then incorporating it into each chapter. The approach is shown to be multipurpose, truly holistic, and effective. The fact that Katehakis does not disregard the usefulness of 12-step programs and pre-existing treatment methods, included throughout the book and in the Appendix, demonstrates her openness and appreciation for the work of others.

This book offers much needed insight into SA and a valuable approach to treatment from an experienced and passionate psychotherapist. Directed towards psychotherapists and other mental health care professionals, it presents a perspective that makes original arguments without ignoring the wealth of knowledge that is already in the field. While some might be off put by it, I welcome her personal touch and connection to trauma and psychotherapy. Her enthusiasm stems from a genuine place which adds appeal in addition to the book’s value as informative, scientific, and relevant.


Lucero Smith is a senior at the University of Pennsylvania, pursuing a B.A. in History with a minor in Urban Education. She has done extensive community engagement work in West Philadelphia schools. She also has experience conducting archival research at the Library Company of Philadelphia and research in problem solving learning. In addition to working for IJP, she also writes reviews for Somatic Psychotherapy Today. 



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