Our very first Sexceptional Lecturer, Dr. David Ley, wrote a blog for Psychology Today that was removed due to legal threat from some in the Sex Addiction Industry. Below is a personal note about his original article.
Note by Dr. David Ley:
“The below post was originally published on Psychology Today. However, the International Institute for Trauma & Addiction Professionals (IITAP), and the sex addiction gurus who profit from the Sexual Dependency Inventory (SDI), threatened Psych Today and forced them to take it down. I don’t blame the editors at Psychology Today. Indeed, I had predicted this would happen, and wrote the editors in advance, to warn them that they should anticipate such threats. Unfortunately, groups such as Psychology Today are quite vulnerable to such threats, and the cost/time/energy required to defend themselves against claims of libel, defamation or other such legal bullying.
I wrote this article, not to attack IITAP or any specific individuals. Instead, I wrote it due to my concerns about patient who are vulnerable to exploitation and maltreatment by clinicians using an unsupported instrument in unethical ways. Prior to publishing it, I had the piece reviewed by no fewer than 5 statistical, research and sexuality experts, several of whom have histories of much greater support of sex addiction than do I. It wasn’t an echo chamber review. I wrote it carefully, in as objective a manner as possible. I complied with ethics around test protection, and copyright, and wrote this within specific compliance with Fair Use protocol, in order to ethically criticize a clinical assessment I believe is potentially harmful.
I’m publishing this blog here, and in emails and on the blogs of other colleagues, in interest of sharing this information widely, and challenging the ways in which the sex addiction industry uses threats and intimidation to suppress criticism or challenges to their methods. I myself have been threatened with legal action by the sex addiction industry at least half a dozen times, merely for challenging them and publicly criticizing the validity and harmfulness of their methods. Multiple of my colleagues have also been threatened in similar ways, for daring to criticize the monolithic, cultlike industry of sex addiction therapists. I welcome anyone to republish this on their own blogs or websites, not to promote myself in any way, but so as to increase the chances that a patient mandated to complete the SDI by a sex addiction therapist, has the ability to learn for themselves the limitations of this instrument.
Since I first published this, IITAP has taken down the SDI Manual which was previously publicly available on their website. This has the unfortunate result of making a test which was already less than transparent, even more obscure to outside criticism, and limiting even more the degree to which a potential patient can be informed about this test.
Here is the full article:
The Sexual Dependency Inventory – An Invalid Instrument?
First published on Psychology Today – Women Who Stray blog of David J. Ley PhD. 9/1/16
Clinical and psychological assessment is a nuanced, and sophisticated area. It’s also a deeply contentious area, with many “pet” assessments which are developed by thought leaders, to evaluate or test their specific theories. Psychological instruments convey a level of science, and therapeutic value, which are sometimes deserved, and other times are used in ways which potentially violate informed consent by patients.
For example – the Myers-Briggs Type Inventory is a test with a great deal of history, often used in business settings and in relationship counseling. But, modern research largely reveals that it is a clinically meaningless and invalid (link is external)test based on antiquated, failed theories. Ethical, informed clinicians no longer use the test, so as not to waste our patient’s time, or to give them the false idea that the test is serving a clear clinical function. The sex addiction treatment industry commonly uses similar outdated and unsupported instruments in ways which pose potentially serious ethical concerns. The Sexual Dependency Inventory (SDI) is one such measure, prominently used by many in the sex addiction industry, despite some alarming weaknesses.
Source: via Wikimedia commons
The Internet is filled with numerous online tests and screening tools which allegedly measure sex addiction. Most of these online tests are free, and appear to work as marketing tools for sex addiction therapists and treatment programs. One however, the Sexual Dependency Inventory-Revised (SDI-R) 4.0, is quite expensive, and commonly used by many sex addiction therapists who sometimes mandate their patients complete the test as a part of treatment. I recently encountered the SDI, in a forensic matter where a therapist had used the SDI 4.0 inappropriately, making custody recommendations on the basis of this test. This case led me to take a closer look at this instrument, which in turn, led to serious concerns about its use in clinical settings. I chose to draft this this post in order to better inform patients who may encounter ill-advised use of the SDI by therapists.
The Sexual Dependency Inventory
The SDI-R 4.0 is described by authors as the only “broadband measure of potentially problematic sexual behaviors and preoccupations…” (Green et al (link is external), p. 127). It is a very long instrument, with over five hundred items, which allegedly assess an extremely wide variety of sexual and relationships issues. I was able to find and download the “SDI R– 4.0 Therapist Manual (link is external)” from IITAP, free on their website and is not identified as restricted or copyrighted. Nevertheless, in keeping with professional ethics regarding test security, I choose not to publish any verbatim items from the test in this article. Quotes used herein are used under Fair Use doctrine, and for the protected purposes of clinical criticism.
The International Institute for Trauma and Addiction Professionals (IITAP) is an organization, founded by Patrick Carnes, PhD. and currently run by his daughter, which established their own training and certification for sex addiction therapists, and offers the SDI-R 4.0 for a substantial fee through their website www.recoveryzone.com (link is external). The test is accessed by individuals through an interesting and relatively unique use of “tokens” which are purchased by clinicians, and then distributed to patients by the therapist. It’s apparently up to the clinician to set the fee for the patient to receive a token which allows them access to the test and report of test results. Most clinicians charge their patients between $85 and $250 per test. (This cost range is supported by the websites of various online therapists, as well as internal emails from IITAP staff.)
The Sexual Dependency Inventory – Revised, 4.0 is a muddled instrument which takes a “kitchen-sink” approach to testing, essentially throwing everything in, to see what sticks. It has few scientific publications describing it or its development. A very early (1998) version of the test was briefly evaluated and showed some initial potential value. However, that version was less than a fourth as long as the currently administered test. There have been no further validity evaluations (link is external)of the SDI-R 4.0 or replications of these results. Applying these initial findings from 1998 to the current version is contrary to industry standards: For instance, each time the WAIS (IQ test) is updated, the makers must develop and publish extensive statistical modeling and conversion scores, to allow comparison of the new version to past results. There is no evidence that such comparisons have been conducted or published. Indeed, in much of what is written about the SDI, it is typically quite difficult to determine what version of the test is being described. When there are apparently substantial changes happening across versions, this is a troubling lapse.
The SDI-R 4.0 now includes within it a number of distinct instruments, such as the Sexual Addiction Screening Test (SAST), tests of attachment, assessments of motivation for change, and numerous items and scales which allege to distinguish or identify various sexual preoccupations, predilections and tendencies. The manual offers little information regarding any over-arching theory which ties these various items and tests together, and merely states “The SDI is actually a whole battery of relevant tests organized into one cohesive report.” (page 3 of Manual). Unfortunately, many of these individual tests have limitations and problems themselves and combining them all into a single measure would require research to evaluate the degree to which these instruments may overlap or even conflict, and whether their combined use leads to increased “convergent validity” in assessment and treatment. Moreover, there could be issues with ordering effect wherein responses to some questions impact how an individual responds to subsequent items. No such research is evident in the manual, or published literature.
The SDI relies of course on the disputed, consistently rejected pop psychology concept of sex addiction, as well as makes references to more unique concepts such as “eroticized rage,” “sexual anorexia,” and “intimacy disorders.” These concepts are used heavily in the theories of Patrick Carnes, PhD., but have not been adopted at a broader level in the mental health or addictions industry. They reflect antiquated and stigmatizing psychoanalytic theories. They are not accepted diagnoses or generally supported theories of psychological practice, mental health, or sexual development. It is also unclear how the items and structure for the SDI were deductively generated or developed. A 2015 paper indicated that during a structural analysis of the SDI, some items were retained as “critical items,” despite evidence that they had no statistical value.
The SDI-R 4.0 includes items assessing sexual behaviors related to various sexual subcultures, from the Lesbian, Gay, Bisexual and Transgender communities, to swinging communities, and those who engage in kink-related or BDSM types of behaviors. These varied items, and issues imply that these behaviors are inherently evidence of disturbance in relationship, sexuality or mental health. There is no evidence in the manual, or in published research, that these items have been normed on members of these sexual populations who are not experiencing problems. As a result, it is quite likely that this test will inaccurately assess individuals who are struggling or questioning with their sexual orientation, kink, or interest in nonmonogamy.
In 1992, SDI author Patrick Carnes wrote (link is external): “The giving or receiving of pain, also known as sadomasochism or S&M, is a type of sexually addictive behavior in which pain is associated with sexual pleasure. There is a blatant imbalance of power between the giver and the receiver, although both partners may be consenting. . . . Victims may perceive their feelings towards their torturer as loving, but there is no genuine trust or intimacy when a relationship is based on hurting one another.” This inaccurate and biased perception of BDSM relationships still pervades the SDI.
People who practice BDSM are often stigmatized inappropriately by sex addiction therapists.