Pornography's Effects on Adults and Children By Victor B. Cline, Ph.D. Licensed Clinical Psychologist Salt Lake City, Utah Note: This is an abridged version of Dr. Cline's article. The entire unabridged version is available in monograph form from Morality in Media, 475 Riverside Drive, Suite 239, New York, NY 10115. For more information, please go to the descriptions and price sheet and the order blank on the MIM Web site. 1. WHAT ARE PORNOGRAPHY AND OBSCENITY? Whether pornography has any significant harmful effects on consumers continues to be a controversial issue, not only for average citizens but also for behavioral scientists. This is not surprising in the light of the fact that two national commissions—the Majority Report of the 1970 Presidential Commission on Obscenity and Pornography and the 1986 Attorney General's Commission on Pornography—came to diametrically opposed conclusions about this matter. Some social commentators claim that pornography is mainly a form of entertainment, possibly educational, sometimes sexually arousing, but essentially harmless. Or, they claim, at the very least, that there is no good scientific evidence of harm. Other social commentators claim more dire consequences and give as examples recent cases, played up by the media, of sex-murderers who have claimed that pornography "made them do it." To ascertain something about pornography's effects, we first need to define it. The word "pornography" comes from the Greek words "porno" and "graphia" meaning "depictions of the activities of whores." In common parlance, it usually means, "material that is sexually explicit and intended primarily for the purpose of sexual arousal." "Obscenity," however, is a legal term which was defined by the U.S. Supreme Court in its 1973 Miller v. California decision. For something to be found obscene, and therefore unprotected by the First Amendment, a judge or jury representing a cross section of the community must determine if the material: Taken as a whole, appeals to a prurient (sick, morbid, shameful, or lascivious) interest in sex; Depicts sexual conduct in a patently offensive manner (i.e., goes beyond contemporary community standards with regards to depictions of sexual conduct or activity); and Taken as a whole, lacks serious literary, artistic, political, and scientific value. The material has to meet all three tests before it can be found obscene in the eyes of the law and its distribution prohibited. This means that something could be regarded as "pornographic" but still not be obscene, such as an explicit sex film produced and used to teach medical students about human sexuality, or a film or book with serious artistic and/or literary value which has some explicit sexual content. Thus, the Supreme Court has protected a wide variety of sexual matter in movies, books, magazines, and in other formats from being prohibited for sale and exhibition to adults (there is a stricter standard with respect to minors). Under the Miller test, however, the distribution of pornographic material which is obscene, such as most of what can be called "hardcore," can be prohibited and penalties proscribed. The distribution of obscenity is prohibited on the federal level and on the state level in over 40 states. While the enforcement of obscenity laws increased after the Attorney General's Commission issued its "Final Report" in 1986, particularly at the federal level, enforcement is at best sporadic in many parts of the nation. This lack of enforcement, especially at the state and local levels, may be attributable, in part, to the view of many people and, in particular, public officials that pornography is essentially harmless or, at the least, that there is little or no real evidence of harm. 2. EFFECTS ON ADULTS In reviewing the literature on the effects of pornography, there is a variety of evidence suggesting risk and the possibility of harm from being immersed in repeated exposure to pornography. These data come primarily from three sources: Clinical case history data Field studies Experimental laboratory type studies As a clinical psychologist, I have treated, over the years, approximately 350 sex addicts, sex offenders, or other individuals (96% male) with sexual illnesses. This includes many types of unwanted compulsive sexual acting-out, plus such things as child molestation, exhibitionism, voyeurism, sadomasochism, fetishism, and rape. With several exceptions, pornography has been a major or minor contributor or facilitator in the acquisition of their deviation or sexual addiction. FIRST STEP - ADDICTION The first change that happened was an addiction-effect. The porn-consumers got hooked. Once involved in pornographic materials, they kept coming back for more and still more. The material seemed to provide a very powerful sexual stimulant or aphrodisiac effect, followed by sexual release, most often through masturbation. The pornography provided very exciting and powerful imagery which they frequently recalled to mind and elaborated on in their fantasies. Once addicted, they could not throw off their dependence on the material by themselves, despite many negative consequences such as divorce, loss of family, and problems with the law (such as sexual assault, harassment or abuse of fellow employees). I also found, anecdotally, that many of my most intelligent male patients appeared to be most vulnerable—perhaps because they had a greater capacity to fantasize, which heightened the intensity of the experience and made them more susceptible to being conditioned into an addiction. One of my patients was so deeply addicted that he could not stay away from pornography for 90 days, even for $1,000. It is difficult for non-addicts to comprehend the totally driven nature of a sex addict. When the "wave" hits them, nothing can stand in the way of getting what they want, whether that be pornography accompanied by masturbation, sex from a prostitute, molesting a child, or raping a woman. These men are consumed by their appetite, regardless of the cost or consequences. Their addiction virtually rules their lives. SECOND STEP - ESCALATION The second phase was an escalation-effect. With the passage of time, the addicted person required rougher, more explicit, more deviant, and "kinky" kinds of sexual material to get their "highs" and "sexual turn-ons." It was reminiscent of individuals afflicted with drug addictions. Over time there is nearly always an increasing need for more of the stimulant to get the same initial effect. Being married or in a relationship with a willing sexual partner did not solve their problem. Their addiction and escalation were mainly due to the powerful sexual imagery in their minds, implanted there by the exposure to pornography. I have had a number of couple-clients where the wife tearfully reported that her husband preferred to masturbate to pornography than to make love to her. THIRD PHASE - DESENSITIZATION The third phase was desensitization. Material (in books, magazines, or films/videos) which was originally perceived as shocking, taboo-breaking, illegal, repulsive, or immoral, in time came to be seen as acceptable and commonplace. The sexual activity depicted in the pornography (no matter how anti-social or deviant) became legitimized. There was an increasing sense that "everybody does it" and this gave them permission to also do it, even though the activity was possibly illegal and contrary to their previous moral beliefs and personal standards. FOURTH PHASE - ACTING OUT SEXUALLY The fourth phase was an increasing tendency to act out sexually the behaviors viewed in the pornography, including compulsive promiscuity, exhibitionism, group sex, voyeurism, frequenting massage parlors, having sex with minor children, rape, and inflicting pain on themselves or a partner during sex. This behavior frequently grew into a sexual addiction which they found themselves locked into and unable to change or reverse—no matter what the negative consequences were in their life. Many examples of the negative effects of pornography-use come from the private or clinical practice of psychotherapists, physicians, counselors, attorneys, and ministers. Here we come face to face with real people who are in some kind of significant trouble or pain. One example from my practice might illustrate this. I was asked to consult on a case where a Phoenix-Tucson area professional person, president of his firm and head of his church's committee on helping troubled children, was found to be a serial rapist who had violently raped a number of women at gun- or knife-point in the Arizona area. In doing the background study on him, I found him to come from an exemplary background and trouble-free childhood. He was an outstanding student in high school and college. His wife, children, business and church associates had not the slightest inkling of his double life or dark side. The only significant negative factor in his life was an early adolescent addiction to pornography which, for the most part, was kept secret from others. This gradually escalated over a period of years, eventually leading to spending many hours and incurring great expense at "adult" bookstores, looking at violent video-porn movies and masturbating to these. His first rape was triggered by seeing a close resemblance in the woman he assaulted to the leading character in a porn movie he had seen earlier in the day. Reality and fantasy had become extremely blurred for him as he acted out his pathological sexual fantasies. In my clinical experience, however, the major consequence of being addicted to pornography is not the probability or possibility of committing a serious sex crime (though this can and does occur), but rather the disturbance of the fragile bonds of intimate family and marital relationships. This is where the most grievous pain, damage, and sorrow occur. There is repeatedly an interference with or even destruction of healthy love and sexual relationships with long-term bonded partners. If one asks if porn is responsible or causes any sex crimes, the answer is unequivocally, "Yes," but that is only the tip of the iceberg. SEXUAL DEVIATIONS ARE LEARNED BEHAVIORS The best evidence to date suggests that most or all sexual deviations are learned behaviors, usually through inadvertent or accidental conditioning. There is no convincing evidence to date, suggesting the hereditary transmission of any pathological sexual behavior pattern such as rape, incest, pedophilia, exhibitionism, or promiscuity. As McGuire explains, as a man repeatedly masturbates to a vivid sexual fantasy as his exclusive outlet (introduced by a real life experience or possibly pornography), the pleasurable experiences endow the deviant fantasy (rape, molesting children, injuring one's partner while having sex, etc.) with increasing erotic value. The orgasm experienced then provides the critical reinforcing event for the conditioning of the fantasy preceding or accompanying the act. (McGuire, R.J., et al., "Sexual Deviation as Conditioned Behavior," Behavior Research and Therapy, 1965, vol 2, p. 185). In my experience as a sexual therapist, any individual who regularly masturbates to pornography is at risk of becoming, in time, a sexual addict, as well as conditioning himself into having a sexual deviancy and/or disturbing a bonded relationship with a spouse or girlfriend. A frequent side effect is that it also dramatically reduces their capacity to love. Their sexual side becomes, in a sense, dehumanized. Many of them develop an "alien ego state" (or dark side), whose core is antisocial lust devoid of most values. It makes no difference if one is an eminent physician, attorney, minister, athlete, corporate executive, college president, unskilled laborer, or an average 15-year-old boy. All can be conditioned into deviancy. THE EFFECTS OF AGGRESSIVE PORNOGRAPHY (PORNO-VIOLENCE) In recent years, there has been a considerable body of research on aggressive pornography, much of it found in "hard R-rated" films. Many of these films are also shown unedited on cable TV and later are available to children in nearly every video store in America. The typical film shows nude females, or females in sexually arousing situations and postures, being raped, tortured, or murdered. The results of this research suggest the possibility of conditioning viewers into associating sexual arousal with inflicting injury, rape, humiliation, or torture on females. Where these films are available on videotapes (which most are), these can be repeatedly viewed in the privacy of one's residence and masturbated to, with the associated risks of negative or antisocial conditioning and behavior, as previously noted. The literature on aggressive pornography is rather impressive in its consistency in suggesting a variety of harms or possibility of antisocial outcomes from exposure to this material. This should not be surprising after 40 years of research on film and TV violence arriving essentially at the same conclusion. In a study by Mills College sociologist Diana Russell, it was found that the depiction and dissemination of the "rape myth" (i.e., that most women really enjoy having sex forced upon them) were significant elements in reducing inhibitions to the use of violence, habituating both males and females to the idea of rape and also accepting sexual aberrance as "normal" behavior. She also found that once the seeds of deviant behavior were planted in the male fantasy, the men were inclined to act out their fantasies. She found that both the fantasies were acted out, as well as the mere conceptualization of deviant fantasies as viable behaviors, led to considerable conflict and suffering on the part of both males and females, particularly in sexual relationships with their intimate partners. (Russell, Diana, Rape and Marriage, Beverly Hills, Calif.: Sage, 1982). THE EFFECTS OF NON-VIOLENT PORNOGRAPHY The issue which has caught the attention of some behavioral scientists is whether it is the violence or the sex that is doing most of the "harm" when it is fused together in so-called aggressive pornography or porno-violence. Some will say, "Just eliminate the violence—the sex is OK." Most therapists, however, as well as most ordinary citizens, would not regard the following examples as healthy models of sexual behavior, but all are frequently depicted in "non-violent" pornography: Child pornography and "pseudo child pornography" Incest pornography (e.g., mother seducing son, daughter seducing father, etc.) Sex with animals Group sex Sex which humiliates and denigrates women and their sex role in man/woman relationships (without overt violence) Obscene films which present a massive amount of misinformation or gross distortions about human sexuality All of the above, while lacking violence, still have the potential of having negative effects on some viewers because they model unhealthy sex role behavior or give false information about human sexuality. Additionally, non-violent porn can contribute to acquiring a great variety of sexual addictions. Additionally, empirical research suggests that when experimental subjects are exposed to repeated presentations of hardcore non-violent adult pornography over a six-week period, they: Develop an increased callousness toward women; trivialize rape as a criminal offense; to some it was no longer a crime at all; Develop distorted perceptions about sexuality; Develop an appetite for more deviant, bizarre, or violent types of pornography (escalation); normal sex no longer seemed to "do the job;" Devalue the importance of monogamy and lack confidence in marriage as a lasting institution; and View non-monogamous relationships as normal and natural behavior. (Zillman, D., and Bryant, J. "Pornography's Impact on Sexual Satisfaction." Journal of Applied Social Psychology, 1988: vol 18, no. 5, pp 438-453; and Zillman, D., and Bryant, J., "Effects of Prolonged Consumption of Pornography on Family Values." Journal of Family Issues (Dec. 1988): vol. 9, no. 4, pp 518-544.). THE CASES OF GARY BISHOP AND TED BUNDY, SERIAL KILLERS Another example of the effects of pornography comes from Gary Bishop, convicted homosexual pedophile who murdered five young boys in Salt Lake City, Utah, in order to conceal his sexual abuse of them. He wrote in a letter after his conviction: "Pornography was a determining factor in my downfall. Somehow I became sexually attracted to young boys and I would fantasize about them naked. Certain bookstores offered sex education, photographic, or art books which occasionally contained pictures of nude boys. I purchased such books and used them to enhance my masturbatory fantasies. "Finding and procuring sexually arousing materials became an obsession. For me, seeing pornography was lighting a fuse on a stick of dynamite. I became stimulated and had to gratify my urges or explode. All boys became mere sexual objects. My conscience was desensitized and my sexual appetite entirely controlled my actions." In the case of Ted Bundy, serial killer of possibly 31 young women, he stated in a videotaped interview hours before his execution, "You are going to kill me, and that will protect society from me. But out there are many, many more people who are addicted to pornography, and you are doing nothing about that." While some commentators discounted his linking aggressive pornography to his sex-murders (when he said it fueled his violent thoughts toward women), there seems little doubt that Bundy consumed a great deal of pornography, much of it violent, from an early age. 3. EFFECTS ON CHILDREN I find in my clinical practice a spill-over effect where pornography used by adults very frequently gets into the hands of children living in the home or neighborhood. This can cause extremely negative consequences. For example, the parents of a 14-year-old boy brought their son to me when they discovered that he was sexually molesting his sister. We found on investigation that cable TV was in the home, and late at night on one of the channels, there were some very graphic, rough, very violent depictions of sexuality. He got up at two in the morning, went downstairs, and watched these films night after night. They became the training manual or "sex education" that triggered him to assault his sister sexually. EFFECTS OF DIAL-A-PORN ON CHILDREN With the sponsorship of the U.S. Department of Justice, I was commissioned to conduct a pilot field study on the effects of dial-a-porn on children (mostly pre-teens or early teens) who had become involved with this type of pornography, and their parents. At the time of the study, any youngster of any age could call these porno lines and get these messages from nearly any place in the country. All they needed was a phone number to call, and the numbers were very easy to come by. If parents put a "block" on their phone to prevent these calls, the children merely found another phone to use. With every one of the children we studied, we found an "addiction-effect." In every case, without exception, the children (girls as well as boys) became hooked on this sex by phone and kept going back for more and still more. In some cases, more than 300 long distance calls were made by particular children. One 12-year-old boy in Hayward, Calif., listened to dial-a-porn for nearly two hours on the phone in the empty pastor's study between church meetings one Sunday afternoon. A few days later he sexually assaulted a four-year-old girl in his mother's day care center. He had never been exposed to pornography before. He had never acted out sexually before and was not a behavior problem in the home. He had never heard of or knew of oral sex before listening to dial-a-porn. And this was how he assaulted the girl, forcing oral sex on her in direct imitation of what he had heard on the phone. Since I conducted this study, Congress enacted legislation prohibiting obscene dial-a-porn messages and restricting access to indecent messages. Many dial-a-porn services, however, continue to operate in violation of this law, and neither the Justice Department nor the FCC is doing much about it. THE VALUES THAT PERMEATE HARDCORE PORN In a study reported to the 1986 Attorney General's Commission on Pornography by Dr. Jennings Bryant, 600 American males and females of high school age and above were interviewed about their "out in real life involvement with pornography." He found that 91% of the males and 82% of the females admitted having been exposed to X-rated, hard-core pornography. Two-thirds of the males and 40% of the females reported wanting to try out some of the behaviors they had witnessed. And, among high school students, 31% of males and 18% of the females admitted doing some of the things sexually they had seen in the pornography within a few days after exposure. This clearly suggests the modeling-effect or imitative-learning effect, as well as "triggering effect," that even non-violent pornography has on human sexual behavior in some individuals. As Dr. Bryant comments, "If the values which permeate the content of most hardcore pornography are examined, what is found is an almost total suspension of the sorts of moral judgement that have been espoused in the value systems of most civilized cultures. Forget trust. Forget family. Forget commitment. Forget love. Forget marriage. Here, in this world of ultimate physical hedonism, anything goes. "If we take seriously the social science research literature in areas such as social learning or cultivation effects, we should expect that the heavy consumer of hardcore pornography should acquire some of these values which are so markedly different from those of our mainstream society, especially if the consumer does not have a well developed value system of his or her own." PORNOGRAPHY AS A TRAINING MANUAL We also have a great deal of information that suggests that pornography is used by sex offenders as a "training manual" in not only acquiring their own deviation but also as a device to break down the resistance and inhibitions of their victims—especially when the targets are children. In an in-house study conducted by the Los Angeles Police Department's Administrative Vice division, in 60 percent of the child molestation cases referred to them over a 10-year period, adult or child pornography was used to lower the inhibitions of the children molested or to excite or sexually arouse the perpetrator of the abuse. In another study of 43 pedophiles, child pornography was found used in every one of the cases investigated. The officers reported the abusers repeatedly saying the same thing: "I used this stuff to stimulate the child, to break down his inhibitions." (The World and I, December 1992: p. 508) It is mainly pedophiles who create true child pornography using children. They do this for their own use as well as to exchange or sell the materials they produce. When this occurs, the children are doubly abused: at the time the films or videos or pictures are made, and when others observe these works in the future and get turned on sexually. Child pornography invariably produces great shame and guilt in the children involved, especially as they get older and more fully comprehend the enormity of their abuse and know that there is a permanent record of their degradation. INTERNET PORN In the past five years porn on the Internet has virtually exploded in volume and is now the leading source of pornographic materials worldwide. Some of my porn addict patients inform me that the Internet has three major advantages in feeding their addictive sexual illnesses. They call them the three "A's": It's easily Accessible, Affordable, and Anonymous. I have had boys in their early teens getting into this wasteland with really disastrous consequences. They told me they actively search for porn on the Internet, keying in on such words as sex, nudity, pornography, obscenity, etc. Then, once they have found how to access it they go back again and again, just like drug addicts. Dr. Albert Cooper, a West Coast university researcher, writing in the Journal of Sexual Addiction and Compulsivity, refers to this as a "cybersex addiction." He indicates that cybersex compulsives are just like drug addicts using the Internet as an important part of their sexual acting out. This is their "drug of choice," often with serious harm in their home lives and livelihood. Dr. Mark Schwartz of the Masters & Johnson Institute in St. Louis says, "Sex on the Net is like heroin, it grabs them and takes over their lives. And it's very difficult to treat because the people affected don't want to give it up." Cybersex compulsives can become so involved with their online activities that they ignore their partners and children and risk their jobs. Another researcher (Putnam) has noted that some cybersex addicts develop a conditioned response to the computer and become sexually aroused even before turning it on. "Simply sitting down to work at the computer can start a sexual response that may facilitate online sexual activities. As with other addictions, tolerance to cybersex stimulation can develop, prompting the addict to take more and more risks to recapture the initial high." (see New York Times, 16 May 2000, F7) Dr. Jennifer Schneider, a Tucson, Arizona, physician, conducted a survey of 94 family members affected by cybersex addictions and found that problems could arise even among those in loving marriages with ample sexual opportunities. "Sex on the Net is just so seductive and it's so easy to stumble upon it, people who are vulnerable can get hooked before they know it." She further commented that the damage can be as devastating as that caused by compulsive gambling or addiction to alcohol or drugs. In her survey of these 94 people in committed relationships she found they experienced serious adverse consequences, including broken relationships from those partners with cybersex addictions. Partners commonly reported feeling betrayed, devalued, deceived, ignored, and abandoned and unable to compete with a fantasy. Among those studied was a 34 year-old woman married 14 years to a minister who she discovered was compulsively seeking sexual satisfaction by visiting pornographic sites on the Internet. She commented: "How can I compete with hundreds of anonymous others who are now in our bed, in his head. Our bed is crowded with countless faceless strangers, where once we were intimate." (New York Times, 16 May 2000, F7). State obscenity laws can't solve the problem since it is largely a national and international problem. However, enforcement of federal obscenity laws (18 USC 1462, 1465) would certainly reduce the amount of Internet porn, since the U.S. is the major producer at the present time. However, these laws are not being enforced; and as a result, distribution on the Internet of hardcore "adult" pornography (i.e., no children depicted) is largely unpoliced in the United States. At the international level, there are no treaties prohibiting hardcore "adult" porn. Filters can be very helpful in discouraging or slowing down young family members from accessing Internet porn, but it should be clearly stated and understood that no filter is absolutely foolproof. A computer-wise user, if persistent, can nearly always breach filter defenses. So caring parents should use filters as partial protection but also have the family Internet computer in a central location where the parents can monitor and supervise its use. It should also be noted that few parents are capable of monitoring their children (especially older children) 24 hours a day. Laws restricting minors' access to Internet porn are needed to help parents protect their children from being exposed to this addictive and often toxic material. Most U.S. libraries allow use of their computers for Internet access but refuse to use filters to protect underage children from harmful exposure to pornography. This means that a seven year-old could potentially access explicit sexual matter representing extremes in anti-social pathology whose source could be from any place in the world. Already we are seeing children sexually abusing other children using the Internet or other media as their instruction manuals. Some might consider permitting exposure of young children to these kinds of materials a form of child abuse or, at the very least, contributing to the delinquency of a minor. 4. OTHER CONSIDERATIONS OF PORNOGRAPHY'S EFFECTS PEOPLE ARE AFFECTED BY WHAT THEY SEE Some Americans strongly hold the belief that pornography, while it may be vulgar and tasteless, is still essentially harmless and has no real effect on the viewer. However, for someone to suggest that pornography cannot have an effect on you is to deny the whole notion of education, or to suggest that people are not affected by what they read and see. If you believe that a pornographic book or film cannot affect you, then you must also say that Karl Marx's Das Kapital, or the Bible, or the Koran, or advertising have no effect on their readers or viewers. Astute businessmen do not spend billions of dollars a year on advertising if their visual and verbal messages and imagery did not motivate people to buy deodorant or diapers or automobiles. The key question is, not whether, but what kind of an effect does pornography have? PORNOGRAPHY AS A FORM OF SEX EDUCATION Sex counseling clinics use explicit sexual pictures, films, books, and videos to change couples' sexual behavior, beliefs, and attitudes. However, these materials are as carefully selected and prescribed as particular drugs prescribed by a physician to treat a specific illness or infection. No responsible doctor would ever send a patient to a pharmacy and say, "Take anything available on the shelf." And no responsible sex therapist would ever say to a patient who had a specifically focused sexual problem, "Go down to the adult bookstore and help yourself to anything you find there." Consider also the spread of sex education courses in schools throughout the United States. The assumption is that you can change attitudes and behaviors about sex through some form of teaching and instruction. If you assume that this is so—still a controversial issue among researchers—then you have to admit that to the possibility that pornography which models rape and the dehumanization of females in sexual situations are also powerful forms of sex education. Anyone who has seen much pornography knows that most of it is made by men for male consumption; is extremely sexist; gives a great deal of misinformation about human sexuality; is devoid of love, relationship, and responsibility; mentions nothing about the risks of sexually transmitted diseases; and, for the most part, dehumanizes male and female participants. Pornography portrays unhealthy or even anti-social kinds of sexual activity, such as sado-masochism, abuse and humiliation of the female, involvement of minors, incest, group sex, voyeurism, exhibitionism, bestiality, etc. If we just examine its educative impact, it presents us with some cause for concern. WHY SOME CLAIM 'NO EFFECTS' Some of the "experts" who publicly suggest that pornography has no effects are just unaware of the research and studies suggesting harm. Others really do not believe what they are asserting. Still others will only reluctantly admit to the possibility of harm from "violent pornography." In some cases, they are pretending not to know because of their concern over what they falsely believe is censorship or loss of First Amendment rights. Some fear the tyranny of a moralist minority who might take away their rights to view and use pornography, then later take away free speech and expression. Some are themselves sex addicts with a hidden agenda behind their public posturing. Thus, for some of them, the issue is political. It also has to do with their personal values and much less with what any contrary evidence might suggest. TREATING SEX/PORN ADDICTIONS Porn addictions are usually the precursor of later full-scale sexual addictions. In my experience two things need to happen when treating these psychotherapeutically. First the addict (and spouse, if they have one) should be treated together by a sexual addiction specialist. They will both need marriage counseling also. Since the innocent spouse is wounded too, she (or he) also needs help. In the process, you also mobilize the innocent spouse to be part of the healing team. You don't neglect them. You all work together. And there is one cardinal rule: "no secrets." Secrets "kill" you. If there is any kind of relapse it must be acknowledged, put on the table and processed in the counseling session. If you hide or lie your illness worsens. Second - you need to join a weekly support group such as S.A. (Sexaholics Anonymous) with their 12-step program. This is a cousin to Alcoholics Anonymous. It's free. All it costs is your time - maybe an hour and a half a week. In my experience this can be very helpful. And in that group you choose a sponsor - someone with long-term sobriety who you can call to get help, advice and support anytime 24 hours a day. You can usually locate these groups by looking in the telephone book business pages under Sexaholics Anonymous. Or you could call A.A. who can usually tell you where to go. I find that for this experience to be helpful you need to attend at least 90% of their weekly meetings. If your addiction is particularly virulent or you also have chemical addictions in addition, then you should attend at least two group meetings a week until you start getting your behavior under control. The core of A.A.'s and S.A.'s success in supporting healing is the fellowship and bond that develops between and among the wounded attendees plus the 12-step program and the influence of the "higher power." In choosing a counselor to work with I have found that the average social worker, psychologist, or psychiatrist will ordinarily not have the training, expertise or special skills to do sex addiction therapy. Thus this may require you to do some research to locate the appropriate therapist. Even going to an ordinary "sex therapist" won't help either. Most have been trained to help individuals with sexual dysfunctions to "turn on" to healthy sex, not to turn off compulsive addictive sex behavior. One thing you could do to find the right therapist would be to attend a meeting or two of S.A. and ask the other attendees who they have found particularly helpful in counseling. Editor's note: We have a fuller discussion of Dr. Cline's treatment and therapy suggestions on our Web site CONCLUSION In this brief essay, it is not possible to review all of the studies on pornography's effects. But the studies and other evidence set forth here still should be sufficient to give the reader a sense of the field, and thus answer for himself or herself the question of pornography's potential to change or influence sexual attitudes and behavior. In my clinical practice, I have treated both children and adults who have been unequivocally and repeatedly injured by exposure to pornography. If anyone still has doubts about pornography's effects, I would suggest that he or she get invited to some meetings of "Sexaholics Anonymous" and personally witness the pain and trauma first hand. In a society where some types of pornographic material are protected by the Constitution and obscenity laws go unenforced, some individuals may choose to immerse themselves in pornography. These individuals should be made aware of the health hazards involved. This kind of knowledge is most important for parents, since most sexual and pornographic addictions begin in middle childhood or adolescence, most of the time without the parents' awareness or the children have an insufficient understanding of the risks involved.