Parents whose children have become so sexually avoidant that they are hanging around the house with little or no motivation to go forth and find someone for themselves have to learn how to handle a child reluctant to move on because he or she has few or no outside relational needs.
PROGNOSIS
The effectiveness of treatment of sexual avoidance often depends on the patient’s motivation to change. That, in turn, may or may not be enhanced by increasing isolation from the partner. The prognosis often improves when organic causes, such as alcoholism; prescription medicine overusage or drug usage; testosterone deficiency; liver disease; diabetes; an endocrine, circulatory, or neurological disorder; or genital-area pathology such as penile phimosis or genital warts can be ruled in and effectively treated.
THERAPEUTIC ERRORS
As one of my patients related, illustrating how therapists often mistreat sexual avoidance, “The first marriage counselor we saw, back in the 1990s, told us to read performance manuals when what we needed was intimacy guides, then to read intimacy guides when what we needed was performance manuals.” As the husband of the couple reported, much of the time, the therapist just sat there and laughed, while his wife sobbed away with a box of Kleenex because he wasn’t having sex with her. The therapist said to him, “Are you kidding? You mean you really don’t have sex?” The final therapist this couple saw (after that, they both gave up and gave in to someone else—as the wife said, “You could see how effective the therapists all were!”) told the husband, “You’re gay, right?” to which the husband honestly replied no, only to have the therapist respond with a most unhelpful, pedestrian, “Then get off the pot.”
PART THREE
SELF-HELP
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CHAPTER 20
Overcoming Shyness an d ^Withd rawal
As an avoidant individual, that is, as someone who suffers from avoidant personality disorder (AvPD), you are shy, scared, and lonely. Fortunately, you can generally help remedy this state of affairs through your own efforts consulting with guides such as my action-oriented, step-by-step reparative guide on self-interventions you, as an avoidant, can use to overcome your relational (social) anxiety over attachment, intimacy, closeness, and commitment and get closer to your family, make more friends, and possibly even form an intimate reciprocal liaison with a significant other in a long-term, lasting, loving, fulfilling, committed relationship.
The following protocol, much of which is based on earlier material here repeated and recast for self-help purposes, offers specific delimited activities useful for preventing and overcoming AvPD—focused tasks that, in my experience, have helped avoidants go from retreat to connectivity. I break this protocol down into small, one-day-at-a-time steps to offer a laddered approach involving going a little forward each day, allowing the avoidant to make continual progress without feeling overwhelmed due to taking relational plunges that are excessive, only to panic, give up, and avoid the cure the same way he or she gives up and avoids so much else.
Of course, not all avoidants need to make changes that are mini-mal/incremental. Some can boldly truncate the process by facing what makes them anxious all at once, perhaps by combining some of the steps and skipping others where mastery is not necessary or has already been achieved. And obviously, not all of my daily exercises will be applicable to or needed by a given individual. Each avoidant person is different, for avoidants are encumbered to lesser or greater degrees by their avoidances; diverse in their fears; living under different external, variously more accommodating or less supportive circumstances; and individually more or less prone to backsliding. Also, completing each day’s exercises is only a start. Selected exercises often have to be repeated more than once until practice makes perfect. What is important is developing a comprehensive, ongoing, personalized game plan adapted specifically to the individual’s preferences and needs, taking into account one’s personal, often unique, situation.
PREVENTION: SELECT YOUR PROFESSION WISELY
Those who recognize in a timely way that they are potentially or actually avoidant should consider selecting a profession that allows them to earn a living should their avoidance persist or worsen. These professions include post office mail sorter, writer/indexer, mountain climber, grave digger, philosopher/poet, psychotherapist who substitutes living vicariously through patients for real-life encounters, animal trainer/ pet shop worker, or circus performer. Some avoidants-to-be might even consider selecting a profession that can help them become less avoidant. These professions include working in a charitable organization such as a homeless shelter or being a greeter in a funeral home, real estate broker, host on a cruise ship, sports instructor in a gym, politician, medical healer, salesman, and cab driver. An example of a profession that should be avoided would be a professional critic, for professional critics cannot help but acquire personal enemies because of their inevitable need to professionally eventually say something bad about someone’s work.
PREVENTION: AVOID INTENSIFYING PREEXISTING AVOIDANCES AND KEEP NEW AVOIDANCES FROM APPEARING
Avoidants should try not to worsen their avoidance by doing the following:
• pushing themselves too far, too fast to become nonavoidant
• associating with avoidant companions, especially those who newly traumatize them in ways that revive old, unintegrated traumata
• self-traumatizing by compulsively and self-punitively reviving and trying to integrate early traumata, repeating them or their
equivalent in the here and now, over and over again, in an attempt, typically futile, to master the past
• settling in to endless punitive therapy with a therapist who revives old and creates new emotional traumata by being confining or making hurtful technical blunders
• going off medication they should stay on
Particularly onerous are actions that actively court rejection like those of my patient who was just too scared to meet a man she liked in person, so on New Year’s Eve, she stood at his window, called him on her cell phone, told him she was down there (in the dark—he couldn’t even see her), asked him to wave back, then disappeared before he could even make that simple gesture to, and unthreatening connection with, her.
ACCEPT AND LIVE BY YOUR GOOD PROGNOSIS
As Oldham and Morris suggest, “People with Avoidant Personality Disorder are luckier than they may think,”1 for unlike schizoid individuals, who suffer from a fundamental inability to relate, avoidants have the ability to relate, but have difficulty realizing it until it is released through formal therapy or self-help (strength of will, singularity of purpose, and persistence toward achieving one’s goal required!). Also, many avoidants get better spontaneously or should external circumstances improve—even when their AvPD is so chronic and severe that they have isolated themselves from most or all human relationships. Another fortunate aspect of AvPD is that unlike many other disorders, AvPD doesn’t leave crippling residue or permanent scars, especially when avoidants have retained a few crucial relationships that they can use as the basis for revival and repair.
DETERMINE TO WHAT EXTENT YOUR AVOIDANCE IS HEALTHY AND PREFERENTIAL AND SO CAN,
AND EVEN SHOULD, BE RETAINED
Avoidance can be healthy when it is not a sign of an emotional disorder, but of a preferential, reasonable, rational desire to be alone or to be left alone. Avoidance is preferential when avoidants, solitary by choice, have built their aloneness comfortably into their lives. They are not rationalizing when they say that they like being self-sufficient and self-contained, independent of others, and their own master, and speak eloquently of how they enjoy the peace that comes with removal and detachment. These are the avoidants we see in public comfortably eating dinner in a restaurant by themselves reading the Sunday newspaper on Saturday night, or fishing by day, day in and day out, alone by the seashore—welcoming the escape from inner turmoil that comes from pulling back from a world they feel is too much to bear. (Often they want to remain aloof but are too embarrassed to admit it, so they say not “I want to disconnect,” but “I am too fearful even to attempt to make connections,” that is, out of guilt, they say that “I am not an independent individual, but a pathologically avoidant person.”)