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It is almost the end of summer and we have had an exciting year! This year welcomed new ECU staff who each brings with them unique contributions to our facility. Every time we have new doctoral interns or staff, I find that it is a wonderful opportunity to review and revamp our services to ensure we are offering the best care possible. As the Director, I am one of the first people that meet the new hires and new students during the interview process and I am always aware that we in this field have to continue to be teachers about the struggles of sexual addiction and trauma. Many who come for interviews have backgrounds in addictions or trauma but not specifically sexual addiction. It is a wonderful opportunity to continue to get the word out about this disease. Each new person then, of course, questions why we do what we do. To have to explain the process that we use here at the ECU is an awesome responsibility and challenges me to continuously research and think about what we do and whether it is the approach that continues to work best. I love my supervisory capacity and believe that it keeps me on my toes and not complacent in the work that we do. I also admire new staff who come in to an existing unit and are able to voice their opinions and challenge us but also bring something new to the treatment. Please see the article that our new art therapist, Judith Curcio, wrote as well as the brief biography on Miriam Paikoff, one of our individual therapists.

This year also brought alumni weekend! This weekend was held in April and, as last year, surpassed any expectations that I had. Hearing from alumni and their spouses about their strength and hope and trials and tribulations always reminds me why I do this work. Alumni weekend is for the alumni but also for staff. I think I speak for all of us when I say that it gives us courage and touches our spirits in a way I could never thank you all for appropriately. I encourage you to go to our website and view some of the materials about and from alumni weekend. This year we had many guest speakers from our "alumni" staff as well clinicians who we consider to be part of our extended ECU family. We presented on topics from back to basics to more in depth topics such as building healthy sexuality. We received lots of feedback for next year that we will incorporate. If you attended and want to be sure that we heard your feedback or want to come next year and would like a certain topic included, contact us.

Dr. Tanisha Ranger and I will be presenting on Schema Therapy and sexual addiction (based on Jeffrey Young and the Institute for Schema Therapy's work) at SASH weekend (The Society for the Advancement of Sexual Health). We have found schema therapy to be such a benefit to our clients. Dr. Ranger first started using this technique with our clients when she was working on her dissertation (her dissertation is titled "Avoidance and Shame: A Schema-Focused Approach to the Treatment of Sexual Addiction" for more information on her dissertation please contact the ECU). She found, and we have continued to find, that this particular therapeutic style really speaks to what we already do at the ECU and has given a language to the clients that they readily grasp. Schema therapy combines some traditional psychodynamic methods with more cognitive behavioral methods. For clients who struggle with understanding where their addiction came from, what trauma they had, what their negative core beliefs are, what their shame messages are, what "needs" their addiction meets for them, or what their shame is telling them- Schema therapy helps them begin to understand this and complements many of the trauma exercises that we have them complete. For more information on schema therapy, please do not hesitate to see us at the SASH conference in September, contact us or look for Jeffrey Young's work and other resources at Schema Therapy.

The ECU is always striving to keep what works and enhance our skills. We are pleased to be a part of many research projects. There is a short article here on withdrawal and sexual addiction from the dissertation completed by Kyle Schultz. We are working on schema therapy research that will be in part presented at the SASH conference but also continue well past that. We are also trying to better understand relapse and relapse rates and working on collecting data in this as well. For those who attended alumni, you helped by filling out a questionnaire there. If you would like to help with this data, please contact the ECU. The questionnaire is brief and can be conducted over the phone or one can be sent to you in the mail. We also have another doctoral intern, Antoneal Swaby, conducting research on the executive functioning difficulties with sexual addiction and look forward to seeing her research compiled in the next year. We will continue to support the efforts of those who are researching this disorder and attempting to help us better understand and create more meaningful care.

This has been a great year so far and I am grateful to be a part of so many lives, to work with clients who have the courage to change and clinicians who work every day with compassion, insight, dedication and humor. I look forward to so many exciting things in the rest of the year and hope that you will continue to include us in your lives.

I came to Keystone Extended Care Unit in March of this year, and am proud to join the team of professionals who work with sexually addicted clients. My background is in Art Therapy (Hahnemann 1972), as well as having a Master's degree in Psychology from Chestnut Hill College (2004). I have worked with clients in a wide range of facilities, and this is the most intense program that I have experienced. Due to the influence of insurance companies, inpatient and partial hospital programs have such a brief amount of time to work with their clients, that the focus is on stabilizing them as quickly as possible so they can be moved to a lower and less expensive level of care.

The four to six week residential program at Keystone addresses all aspects of sexual addiction. Healing work is done on all levels—cognitively, behaviorally and experientially. Art therapy brings a unique approach, as it encourages clients to tap into their inner selves through the making of art. They then process what they have drawn, and receive feedback and input from their peers in order to develop insight into their addiction. I also bring an interest in and experience with meditation and Tai Chi, and have incorporated those principles into some of the art therapy and the psycho-educational groups. There are endless ideas for art therapy topics—the following are from some of our recent Keystone Art Therapy groups:

Create a Community Mural—the group is asked to draw an imaginary community on a large mural sheet. Each person adds what they feel they would like to offer/bring to this community. Among other things, the group process is examined—who emerges as leader, what other roles evolve, and how that relates to each person's behavior toward others.

Design a Box—to contain specific feelings such as anger or sadness; to contain positive affirmations and spiritual "first aid" in times of need; a box with the inside representing your inner self, and the outside representing how others see you.

I also like to bring meditation into the experience, and the following are some examples of what we have done this summer:

Draw a Safe Place—Group started with a guided imagery exercise to locate a "sacred space." Then group members were asked to create artwork to express the safe place that they discovered on their inner journey. This was also an exercise that I offered at the yearly Keystone Reunion last spring.

"Portrait of your Addict"—the group begins with guided imagery that helps the client go deep within to see a portrait of his addictive self. Then he was asked to create some artwork to reveal what was seen on this inner journey.

My particular style is more intuitive than analytical—I believe that the making and sharing of art is an intrinsically healing experience. We also explore the hidden messages that may be unintended, but can be very significant. Group members offer insights to a peer who is presenting, and the process supports and reinforces material that is covered in other groups. Mutual trust is established.

The groups become a very powerful source of strength that enables the clients to become vulnerable and honest about issues that have previously been shrouded in shame. I like working here because there is so much to learn—from each other as well as from the clients. I am privileged to be a part of a team that is focused on healing and recovery.

*Please keep a look out for Judith's upcoming art therapy podcast as part of our ongoing staff podcast series.

Muddy Waters by Jim L.

The last time I called Keystone, Milton put me on the speakerphone so the guys could ask questions. I remember two of them. Did I like Keystone and did life in sobriety offer any excitement?

The first question is easy. No, I didn't "like" Keystone. I don't think I was supposed to like offending cycles, image lists, living in denial, facing consequences, or psychodramas.

Just because I didn't "like" Keystone, however, doesn't mean I didn't benefit from it. No one likes a blood transfusion, life-saving though it may be. I left Keystone with a sense of how I had let Internet pornography highjack my life. I left determined to break free of the prison I had created for myself. And I left with practical tools, insights, and strategies to make this possible. For these contributions, I am forever grateful.

Is my life in recovery exciting? In my case, that means life without pornography. That's a great question for an addicted mind to ask. For underneath it lurks the fear of withdrawal, the loss of the drug. Any addiction can mask itself in excitement, from drinking and doing drugs to smoking or shopping. They all cloak themselves in necessity, variously defined.

To check this out, consider a substance or activity to which one is not addicted. In my case, a good example is alcohol. As part of my pre-sentencing agreement, I have to abstain from drinking. Initially I resented this. Now, I don't really care. My life is just fine without it. Friends come to my house and drink. It's not a problem. Basically, alcohol has no power over me. "Excitement" in my life simply doesn't require drinking.

Pornography, whether Internet-based or not, is a whole different story. I don't have Internet access at home, nor do I carry any device with such capability. I was a porno junky far too long to play with fire. I simply don't want or need such "excitement" in my life.

For me, recovery means new patterns of behavior, in both thought and action. I think of my mind like it's a glass of water. Pornography muddied it up. My job is to run as much clear water into that glass as I can. I do this every day. It's a gradual process. I just can't wish the mud and dirt away. I have to work at it. Adding "clean" water can be washing dishes, installing a new sink, painting the house, or working in the garden. It can be reading, meditating, doing Qigong exercises, or listening to books and lectures. Essentially, I am creating a spiritual practice for myself. That practice isn't just something I think about, it's something I do.

Every time I go to an SA meeting, bake a loaf of bread, or try out a new recipe, I am running clear water into my class. That's not to say I don't have bad days when I end up muddying the waters. By this I don't mean just the intrusion of sexual thought patterns. I am also thinking of resentments, self-righteous judgments, and self pity, all of which take their murky toll. Clearing things up takes time; it's a matter of small gains on a daily basis. The acquired self is always in a hurry, demanding results immediately. The soul is patient and values stamina. When it comes to recovery, I am in for the long haul.

The more I stick to compassion and gratitude, the clearer the water gets and the less I miss the mud. That's excitement enough for me.

Jim L. pled guilty to one count of possession of child pornography; he is still awaiting sentencing. Jim was at Keystone in 2008. He has 30 months of sobriety.

Examining the Possibility of Withdrawal from Sexual Addiction

Only recently has the term sexual addiction found its way into popular vernacular. With well-known public figures confessing to having an addictive relationship with sexual behavior, the diagnosis is now gaining more and more public attention. When these celebrities went public with their struggles, many people wondered: "Can you really become addicted to sex?" It is a relevant question to ask because up to this point addictions have been solely linked to excessive alcohol or drug use. More recently, research is accumulating pointing towards another type of addiction: behavioral addictions.

Also known as process addictions, behavioral addictions are understood to occur when a person becomes addicted to a behavior because of the short-term rewards they gain from performing the behaviors. Things like having sex, working, eating, and spending often produce positive feelings when people carry out these behaviors. When people experience positive feelings, the neurochemicals in their body (i.e., dopamine, serotonin, norepinephrine, cortisol, etc) are activated. Researchers and clinicians hypothesize that those who struggle with behavioral addictions have become addicted to the chemical process associated with their addictive behaviors. Ironically, they become addicted to a substance. The substance is produced by the body and not ingested, as is the case with drugs and alcohol.

Despite the growing number of people presenting for treatment related to behavioral addiction, there has been no hard neurological research to back up these hypotheses. The studies that have been done have attempted to highlight the similarities in symptom endorsement between those addicted to behaviors versus those addicted to a substance. The experiences of powerlessness, unmanageability, tolerance, withdrawal, etc have been documented for some of the behavioral addictions but there is still a debate as to whether behavioral addictions constitute an addiction in the classical sense, or if it might be a variant of obsessive or compulsive behaviors, or something altogether different.

To help contribute to solving this question, a study was performed at the Keystone Center Extended Care Unit (ECU) that examined 52 client's experience of withdrawal after they presented for treatment of sexual addiction or compulsivity. The purpose of the study was to document whether or not clients endorsed withdrawal symptoms after undertaking a period of abstinence from sexually addictive behaviors, what symptoms were most frequently endorsed, and how intense were these symptoms. All clients who present for treatment at the ECU are asked to abstain from sexual behavior not only during their time in treatment, but also 2 months after. Those who agreed to participate in the study filled out questionnaires designed to assess their experience of withdrawal at intake, twice weekly for the duration of their stay on the unit, and 2 weeks, 1 month, and 3 months post-treatment.

Results indicated that shame, loneliness, sadness, frustration, feeling stressed, fatigue, and changes in sleep were the most significant symptoms experienced during abstinence from addictive sexual behavior. The study found that physical and psychological symptoms were most intense during the initial assessment when clients arrived at the clinic. There was a gradual decrease in symptoms during the first two weeks, with a slight increase during the end of the second week. Overall, psychological symptoms were endorsed more often and more intensely than physical symptoms. These findings suggest the possibility of a withdrawal period when undertaking abstinence from sexually addictive behavior.

Further research needs to be conducted to clarify and confirm some of the findings from this study. Regardless, the patterns that emerged suggesting a withdrawal experience from sexual addiction indicate in an increased need for clinical attention to be paid to those who are attempting to abstain from addictive sexual behavior. The current study could be used as a model for examining other behavioral addictions as well, and the possibility that they too might experience withdrawal symptoms as a result of stopping their addictive behaviors.

~ Kyle Schultz, Psy.D, M.Ed

If you would like to view the full paper from which this article is derived, please email the author Kyle Schultz.

The Extended Care Unit's 2011 Annual Alumni Reunion was open to alumni and partners of our alumni. It was a weekend full of informative presentations, close friends and a continued dedication to recovery. The entire ECU staff was thrilled to reconnect with so many familiar faces and it was wonderful to receive such positive feedback from all of the alumni. We would like to take this opportunity to commend our alumni on all of their hard work and progress. We would also like to thank our guest speakers Jay Parker (CDP), Dr. John Giugliano (PhD), Jennifer Enigk (Psy.D), and Carol Conklin (LCSW). Alumni from many years past and around the globe showed up for the 2011 Reunion. It was inspiring to see everyone so dedicated to their recovery and with roughly 80 alumni in attendance, it was an extremely positive, emotional and fulfilling time for us all.

Please take a moment to review our Alumni Reunion Recap page where you can find a list of all our presenters along with a synopsis of each presentation. You will also find a link showcasing past alumni reunions! You can find us online.

If you are a clinician and are interested in presenting at the next alumni reunion (Tentative: April 2012), please email Steven Bocchinfuso.


In October of 2009, the Extended Care Unit began its ongoing podcast series. The series is geared towards clinicians, assistance professionals, sex addicts, family, partners and the spouses of sex addicts. We continue to add new podcasts throughout the year. Keep an eye out for our next podcast on treating Sexual Compulsivity using Art Therapy. To date, we address a variety of informative topics, including a multimedia presentation on our Professional Assessment Center, information regarding self care, defining sex addiction and a discussion on healthy sexuality and intimacy. We invite you to join us online for this online series at News & Events or just go online and click on the "Presentations & Media" link. Do you have a topic that you would like to hear discussed? If you have any suggestions for future podcasts we would love to hear them! Please email your suggestions to Steven Bocchinfuso.


Listen to our alumni share their stories of recovery and perhaps share them with your clients and peers!

The Keystone Center ECU invites you to listen to our all-new Alumni Podcast series online. In this series, we sat down with a collection of our alumni while they were attending our annual alumni reunion. The result is a compelling group of individual stories that dive into the depths of struggling with sex addiction, exemplify the power of recovery and prove to those seeking treatment that they are not alone. Visit this powerful alumni podcast series.

2011 SASH Conference
(ECU speaking engagement)
September 21st to September 24th 2011
(ECU Presentation: 9/24/11)
Hyatt Regency La Jolla Hotel,
San Diego, CA

The Keystone Center ECU will be presenting, attending and exhibiting at the 2011 SASH Conference (The Society for the Advancement of Sexual Health). On Saturday, September 24th our Clinical Director, Mary Deitch, JD, Psy.D, will be teaming up with the ECU's Tanisha M. Ranger, Psy.D to present on "The Sex Addict's Schema and the Drive to Act Out." During Session 9 at 1:30PM, The pair will be giving what is sure to be an insightful presentation on the applications of Schema Therapy in treating Sexual Compulsivity.

The ECU is an ongoing supporter of SASH and is happy to contribute to their efforts to advance the field of Sexual Health. We look forward to seeing all of our colleagues at this years SASH Conference.

*To learn a little more about schema therapy please review our opening "Letter From The Director" in this edition of the newsletter.

The Keystone ECU Local Case Conference Series
Remaining 2011 Dates: October 14, 2011 & December 16, 2011 (12:30PM)
Keystone Outpatient Conference Center
5000 Hilltop Drive, Brookhaven, PA 19015

The Keystone Center ECU recognizes how important and valuable it is to collaborate with local resources. This Case Conference Series is a forum in which you can discuss your cases with your peers and help everyone to serve our area's collective client population in the best way possible. If you would like to attend, have a case discussion in mind or want more information on how to present case conference materials, please contact Dr. Mary Deitch or Steven Bocchinfuso to register your free attendance.

View full details and flyer at News & Events.


Recovery from sexual addiction and trauma is painful and difficult. This is true for the recovery of spouses, partners and families. Many of you went through a family therapy process at Keystone and possibly before and continuing after. As you know, sexual addiction can have traumatic effects to family members. Even knowing where to turn, who can be trusted, what to do about the future can be overwhelming- not to mention the disclosure process. We at the ECU would like to help bring in more resources for the family members, you! As many of you may know, we have an alumni list for our clients. This list is created when alumni request to be put on the list when they leave the program (or any time after) and given to every departing client. We would like to do something similar with families but offer it to the families even prior to conducting family therapy sessions. It is our hope that the more support from those who have gone through the family therapy process the better the outcome for the family member. Further, by helping you connect with other families who have gone through the ECU process, it may serve your healing. Many of you may have meetings in your area or have utilized the phone meetings but many of you may not have had access to these for whatever reason or simply be looking for more support.

So what are we asking? Whatever it is that you want to and can give. If you would like to write something for this newsletter or to be given to incoming families that would be helpful. While we know that everyone's experience will be different; hearing a story, having something to relate to, getting any guidance could be beneficial. If you would like to be a part of a family alumni list (to be given to spouses and families prior to coming in for therapy), please send us your information. You can give as little or as much information as possible (e.g. if you only want to give phone numbers or email).If you are willing to be a support person for someone as they leave disclosure or other sessions, please note this. If you are wanting only those in your state to contact you or want to know who else there is in your area, please note this as well. This is new for us and we are willing to structure this in any way possible to maximize its benefit. Our hope is that this list will grow over time and we will be sure to update you on our progress.


Helping Couples Further Their Recovery Process

We at the ECU are proud to present our first couples intensive November 4th, 5th and 6th! This intensive is aimed at couples who have started some basic work on their recovery but want an in-depth look and intensive program to better understand themselves, their partners and their relationships. This program will look at individual relationship and family histories and help to process patterns that exist. Each individual will look at their schemas and how it relates to interpersonal connections and pairings. There will be discussions and in-depth processing of love and intimacy and healthy sexuality as well as boundaries and communication styles.

Each couple will be able to bring in specific issues that they desire to heal from in their relationship and gain access to experts in the field of sexual addiction and family therapy and other couples to aid in their process.

This intensive will be limited to only a handful of couples to maximize the amount of time and intensity of the program. Each couple will be treated as an individual system with unique goals and strengths and concerns while benefitting from the group therapy experience.

This intensive is not limited to ECU alumni and is open for those who are in the process of recovering as a couple. The couple should have some recovery from sexual addiction and be looking to strengthen their relationship and move forward together.

The first intensive is scheduled for November 4th, 5th and 6th and will be 2 full days and a half day on Sunday. The intensive will be held in the Keystone Center's new outpatient facilities located in Brookhaven PA. For more information and to register, please call the ECU at 800-733-6840 or email Dr. Mary Deitch. Please hurry as space is limited! For information on future Couples Intensives, stayed tuned to our webpage.


Judith Curcio, AT, MS has been with Keystone since March 2011. Her background is in Art Therapy (Hahnemann 1972), as well as having a Master's degree in Psychology from Chestnut Hill College (2004) she has worked with clients in a wide range of facilities. Judith is a welcomed part of the team. Be sure to check out her article on Art Therapy in this issue of the ECU newsletter to learn more about her role at the ECU.

Miriam K. Paikoff, LSW has been with Keystone since March 2011. She graduated from the University of Pennsylvania School of Social Work in 1993 where she earned her Masters degree. She has experience with outpatient drug and alcohol addiction treatment and working with people with HIV/AIDS. At Keystone, she works with clients individually and co-facilitates groups. She has interests in trauma and grief/loss work and co-occurring disorders. She is excited about joining the staff at Keystone and feels she has definitely grown as a clinician in the short time she has been on the staff (and has learned how to drive a huge van!) When not at Keystone, Miriam enjoys spending time with her three children and her husband.



The ECU newsletter is distributed to outside clinicians, alumni, potential admissions and all those curious about sex addiction. If you are reading this newsletter, you are eligible to write your own story or article. Interested in sharing something in our next newsletter? We would love to hear from you! Please contact us at 1-800-733-6840 or email Steven Bocchinfuso.

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