Counseling Casey

I was immediately attracted to her, which was a problem. She showed up in my office early Monday morning, catching me off guard.

"I'm Casey," she said in a timid voice, not giving her last name. I drew a blank, still tired from the long weekend I'd spent down the shore fixing up our beach house for the coming summer season. Then I knew exactly who she was. She was the sex addict whose aunt had called the week before trying to schedule an appointment, but there was an issue with her insurance. Tom, who does our medical billing, was arguing with her on the phone, explaining we needed approval from her provider before Casey could come in for an evaluation. Friday, her paperwork came through.

"Good morning," I said, and took a seat at my desk across from her. I made a conscious effort to sound welcoming. "I'm Randal Adler, licensed professional counselor. You can call me Randy."

"Hi Randy," she said, coming a little further out of her shell. Her pretty red hair hung limp in her face. She had a lip-ring, and a tiny diamond in the left nostril of her freckled nose. She was wearing running sneakers, pink running shorts, and a tank top - one bra strap showing on her thin pale shoulder.

The strap caught my eye, but I quickly looked away.

"I just came from the gym," she said. "I went there three times this week. My aunt said I have to go in order to live in her house. She's paying for it. I went three times so far."

"Great," I said. "Exercising is a big part of recovery. It releases natural endorphins, helps the dopamine receptors repair themselves."

"I feel better when I exercise."

"Most people do."

"I really think I'm going to keep it up this time."

"I hope you do." I smiled at her. She looked like an athlete, underneath her hard, street-girl exterior, that is. I pictured her running on the treadmill for an hour at a clip, a distance runner's body if I ever saw one, especially the thin ankles. I felt this annoying pang of sexual attraction toward her. I would not take her on as a patient, not at this point in my career. I was 52 and married, with two dogs, a big suburban home, and a house at the Jersey shore. Casey was single and 24, and lived with her aunt in the Irish working class section of Philadelphia called Fishtown. I knew this because I'd read it in her chart.

I opened my laptop and began her evaluation, asking the standard questions, trying to think of other therapists who would be a good fit for her. She was a self-identified sex addict who was already in recovery from methamphetamine, which she hadn't used in over a year. Her home life and upbringing were tough. She never knew her father. Her mother passed away from a fentanyl overdose when she was 14, at which point she was taken in and adopted by her mom's sister. Addiction ran in her family, as did depression.

She wasn't suicidal or homicidal, but had been diagnosed with Bipolar II, which may have explained the hypersexuality - her addiction to sex. She had mood swings and trouble with interpersonal relationships. She also spoke of feeling empty and unworthy.

"I don't have sex because I'm depressed," she told me. "That's not why I do it."

"Why do you do it?"

"Because it's fun. Because I like it."

"Do you think you're addicted to sex?"

"I guess so. I don't know."

"You don't know?" I asked. "You're here in therapy, right? So you admit you have a problem?"

"Sure."

"Do you feel your behavior is reckless and impulsive?"

"Maybe," she said.

"How often do you have sex per week?"

"One or two times."

"Just one or two?"

She shrugged. "Maybe like three or four times."

"With how many different partners?"

"Three or four," she said. "I hook up with a lot of the same guys, though. I make them wear protection."

"Okay," I said. "But didn't you also say that sometimes they forget, and you worry about catching an STI?"

"Sometimes," she said.

"And then there's the fact that you go out late at night to clubs looking to have sex, often alone, sometimes with strangers you've met online. And that you find yourself in men's apartments doing things that scare you, that make you feel out of control—"

"I like to have sex," Casey interrupted. "I know it's a problem."

"Okay," I said, smiling. "I'm not judging. This is a safe place." It got quiet then. She was sitting Indian style in her chair and I could see her panties through her running shorts. She wasn't paying attention. She was texting someone on her cellphone.

I typed "Bipolar II" into her evaluation on my laptop, along with "risky and impulsive sexual behavior." I also wrote that she was in recovery from methamphetamine, and had been sober for 13 months. Apparently, she'd done it on her own, without going to 12-step meetings or getting a sponsor, and without medication. I was impressed. This was extremely difficult to do at age 24, especially in Fishtown. She was at the prime party age, with all the temptations of friends, and clubs, and bars, and new designer drugs coming out every day.

She was still casually sitting in that un-ladylike position in the chair, completely unaware that her beaver was showing. In a flash I saw all the way up her running shorts, past her panties to her fuzzy crease. Her clit was pierced.

A tingle went through my penis. I would not take her on as a patient. We were not a good fit.

She put away her phone. I smiled, making eye contact. I waited. She waited. I wouldn't speak first, that was the protocol. I was here to listen. She put her hair back into a ponytail, and realized her shorts were riding up on her and causally fixed them.

"I don't regret it until the next morning," she spoke up.

"What's that?"

"The sex," she told me. "Sleeping with random guys. I don't feel bad about it until the next day."

"Tell me more about that. About how you feel."

"Guilty," she said. "And scared. Like I made a mistake. Like my reputation is totally ruined. I get panicky and think I'm going to die. I start to think that I caught a disease or am pregnant, or that I'm just going to die. I hate the next mornings. I always promise myself I'll stop, that I won't do it anymore - go out and fuck random guys, have anal sex and all that. Then I shower and go to the gym, or go to work. I start to feel better. The world doesn't feel like it's going to end anymore. I realize I'm not pregnant - I'm on the pill - and that I probably don't have any diseases. It was all in my head."

"I see."

"By afternoon, I'm okay again. By dinner, the thoughts start to creep back in, the thoughts of going out again, or meeting up with some hot guy online. Sometimes I'll start to surf the web, you know, look at pictures and videos..."

"Profiles of guys?"

"Yeah, and other things."

"Like what? Pornography?"

"Yeah," she said, embarrassed.

"How often to do you look at pornography? Everyday?"

"Pretty much."

"Do you ever look at pornography at work?"

"Sometimes. When I'm bored. I do it on my phone. I'd never use my work computer. I don't want to get fired."

"Where do you work?"

"At U-Penn hospital. I'm a clerical assistant."

"Have you ever had sex at work?"

"No. But I masturbate sometimes. In the bathroom."

"Have you ever had sex with a co-worker?"

"Yes, but not at the hospital. I had anal sex at my aunt's house with a guy named Cedrick. He's an orderly on the third floor. No one from my department."

"Does that make it okay? That Cedrick's not from your department? Does that make it less impulsive and risky?"

"Probably not."

I put this all down in her chart. It was nothing that I hadn't heard before. I'd been an LPC for over 25 years, and had specialized in addiction counseling for 15. Gambling, drinking, drugs, sex, work - it was all basically the same stuff. Granted, some of the behaviors were more destructive than others, but it all stemmed from the same roots. I knew firsthand. I was both a recovering alcoholic and porn addict. I'd been sober for 20 years, since I was 32. I'd been off the porn for nearly 10 years, with a minor setback in my mid-40s.

Technically, I guess I was a full-blown sex addict, just like Casey. But I was a straight man, which limited my options. I didn't have the ability to go out and fuck three or four random women in a given week, even when I was in my 20s and 30s. I wasn't "hot," not in the way you needed to be to get laid like that. I was handsome and in good physical shape, lean and muscular with a broad chest and a full head of short, salt-and-pepper hair. People commented that I had strong forearms and hands. I tanned well in the summer, and in the winter, grew a full, hearty beard. Still, I only got limited attention from women, probably because I kept to myself, which was fine by me; at 52, with a wife, two dogs and two houses, I didn't need the distractions or temptations.

"Okay," I said to Casey, closing my laptop, "I appreciate your candid responses. At this time I'm not going to recommend any medications, so you won't need to see Dr. Rueben, our psychiatrist. I think you'll benefit from cognitive behavioral therapy, which basically boils down to skill building - breaking bad habits, thought patterns, and routines, and developing new healthy ones. At this point it's unclear who will be your therapist, but I would definitely start attending 12-step meetings daily, and get a sponsor. I can give you a pamphlet on where to find them in your neighborhood. You live in Philadelphia, right?"

Casey nodded. "Yes, I live in Fishtown."

"Great. There's a number of meetings in that area. Here, take this. There's actually a beginners meeting at 7:00 p.m. tonight, in the basement of St. Gabriel's. I've heard good things about it. You'll feel comfortable there. St. Gabriel's is good people."

"Okay," Casey said, taking the paper.

"Right," I said. "Good luck. Tom will be in touch with your aunt concerning your therapist, and when to schedule your next appointment. Take care. I wish you the best in the future."

"Thank you," she said, stood up and left.

***

That night after my evaluation with Casey, I had really great sex with my 48-year old wife, Nicole. She still looked good after all these years, to use the famous cliché. Still had those great tits and curvy body, and that great long brown hair. Earlier in the day, she'd gotten hit on by a couple of college kids at the 7-Eleven, and was still buzzing from it.

I saw the look in her eye and grinned. There was this incredibly arousing sleaziness that surfaced in Nicole every so often, a nasty seductive invitation to violate her. That night she instinctively sensed something sexual going on inside me, could smell Casey's presence, sniff it out. She needed to mark her territory. Her body responded by firing her libido, momentarily sending her into heat.

We fucked in the living room, not bothering to go upstairs. It started with heavy tongue kissing on the couch, my hands groping between her thighs, reaching under her panties and slipping my fingers into her. She moaned and spread her legs further, grabbing the back of my head and burying my face in her mound.

I ate her pussy and she came hard, grunting and making her nasty orgasm face, hips trembling. She got up, took my pants and underwear completely off, and gave me one of her signature raunchy blow-jobs, sucking and slurping like a fucking pig. The living room blinds were open, but it was late spring and still light outside. The neighbors probably couldn't see inside, not really, but there was that slight chance. It depended on how the light was falling. I saw in Nicole's face she knew it was a possibility, and she winked and went down on me, slurping louder, jerking faster. I was rock hard, the hardest I'd been in months. My cock was so stiff it throbbed.

"Now fuck me," she said, and got on all fours, shoving her ass in the air. An airplane rumbled across the sky, it's shadow passing on the living room wall. Our dogs started barking in the backyard.

I got behind her, grabbed her ass cheeks and spread them open. I reached down and played with her soaking cunt, making her moan. I slide my cock in her from behind and fucked her doggie style, ramming her hard. Her brown asshole seemed to be pulsing, hungry for penetration. I heard Casey's voice then, in my head, out of nowhere. I like to go out and fuck random guys, it said, and have anal sex with them. Twice Casey mentioned anal sex in our session that morning. She obviously liked getting fucked up her ass.

I was going to come soon, but I wanted to hold back. Since I turned 50 it was usually the other way around: I had to concentrate to have an orgasm during sex. Nicole did too. At any moment we could lose the momentum and not be able to finish, like a bird suddenly flying off. Not now. After that counseling session with Casey, I had full control of things. The orgasm was there, just waiting for me to pull the trigger.

I wanted Nicole's ass, wanted to slide my cock right into her dirty brown hole. I stuck my middle finger up her ass, startling her. She tried to go with it and I got excited. It was going to happen now, finally. Anal sex. She was ready. I put a second finger in her ass when she reached back and grabbed my hand.

"Don't," she said, looking me dead in the eyes. And that was that. There would be no anal sex tonight. She turned back around. My dick was still in her, still hard. I finished fucking her in the pussy, not the ass. Thirty seconds later I was coming inside her. It was an intense orgasm, one of the best in a long time. I wanted to pull out and shoot all over her backside - watch the cum cover her asshole and run down her ass crack - but thought better of it. Nicole liked when I came in her, which made sense. It made her feel loved, feel whole.

I was her husband, after all.

***

I was still all keyed up over counseling Casey. That night in bed, after Nicole was asleep and breathing heavily next to me, I left the bedroom and jacked off to Casey in my study. I thought of her pussy and clit ring again, the beaver shot she gave me sitting in the chair. I pictured 69ing her, and what that would be like. I pictured her asshole, right up in my face, close enough to whiff and lick out. I came quick, the orgasm surprisingly strong for just coming inside Nicole a few hours before.

I quietly climbed back into bed, feeling guilty. I hadn't watched any porn that night, but my fantasizing about Casey was uncomfortably close to it. It was disrespectful to my wife, whom I loved dearly, more than anything in the world. It was disrespectful to Casey, too. She'd come to me for therapy, gave me her trust. I couldn't violate it by masturbating to what she told me in treatment.

I thought about my fixation on anal sex, on my preference for women's asses. I was clearly an "ass man," and liked ass more than pussy, tits, legs, and feet. Pussy and tits were fucking incredible, absolutely, as were legs and feet - especially feet. But in the end I always came back to a chick's asshole. Back when I was actively watching porn in my 20s and 30s, back when adult video stores still existed and sold DVDs on shelves, my porn collection was mostly anal flicks. Not mostly, entirely. My college roommate had once said, "What the fuck, dude? Don't you have any other videos besides chicks getting fucked in the ass?"

I didn't. What was the point? Pussy fucking was great, but it wasn't the top of the mountain. Pussy eating was great too, but it wasn't like cock sucking, especially when that cock just came out of another chick's ass. By the time I was 30 I'd outgrown my obsession with lesbians, too. It was a genre that was becoming quite tiresome. There was no closure in lesbian pornography, no real climax. A good porn needed a healthy cum load to finish it off, a nice load shot up a chick's ass or squirted all over her face. That was key.

The absolute pinnacle of porn raunch was ATM - also known as ass-to-mouth. Anal and oral. No, anal then oral. To porn diehards, it was the equivalent of mainlining heroine. Why? I had a theory. It was rooted in Freudian fixations, clearly connected to events in childhood. But it was more complex than that. It had to do with the forbidden nature of putting things in your ass, and then in your mouth. It was dirty and unnatural.

But paradoxically, it was also very natural. Mother Nature had designed humans with pleasure centers in their asses, which made having a bowel movement an enjoyable thing to do. She did the same for the human tongue and mouth, which came equipped with the instinctively pleasurable sensation of suckling and tasting things, like a mother's breast.

ATM was baked into us physiologically, at a very biological level.

There was the psychological element, too. The giving end of ATM was sadistic and powerful, violating another person's most vulnerable regions, then making them literally taste their own ass. The receiving end of ATM was masochistic and perhaps even more exhilarating, the deliciously helpless feeling of total surrender, of giving yourself completely to another, of getting penetrated deep, deep inside, to the very depth of your being.

Sociologically, ATM was the forbidden fruit. Literally. For years anal sex was against the law in many states, and much of America's Puritanical society was disgusted by the very idea of it, of doing something so sinful, so filthy. This built-in repression made the tension around anal sex greater, the fire in people's loins hotter. Fucking someone up the ass, or getting fucked up the ass, became that much more desirable. For centuries around the world, people could not stop themselves from doing it. Just think of the Romans and Caligula's perverted sex orgies, or the Greeks and their nasty man-love, or the lustful Sodomites in the book of Genesis, and their penchant for fucking their fellow villagers in the ass.

ATM was all these things, not the least of which was to be loved and accepted.

Nicole knew since before we were married that I wanted to get inside her ass, just like she also knew - but absolutely refused to allow herself to admit - that I secretly liked being on the receiving end of things. She wouldn't stick her finger up my ass, not a chance. Just like she wouldn't let me stick my finger up hers. Any person who voraciously watched anal sex videos secretly wanted to be on the receiving end of it, that's what I came to realize after two decades of treating sex addicts, and after working through my own addictions. The intense pleasure of watching anal porn stemmed from the unconscious desire to experience the bliss of getting fucked up the ass.

I knew this, just like Casey did. Was I gay? A homosexual? Not at all. My fixation on cock sucking and ass fucking seemed to suggest as much, but it wasn't true. I liked women, a whole, whole lot. Still, I couldn't help wondering if this was why Nicole and I didn't have any children. That at a subconscious level, I preferred ass play over pussy. You can't impregnate a woman by fucking her ass.

This was bullshit, of course. Nicole had cervical cancer in college, and couldn't have kids. And neither of us wanted to go through all the hassles of adoption, spending $30,000 on fees and on lawyers, only to have to keep the adoption open to the biological mother, or worse, to have the mother back out at the last moment and keep the baby for herself.

"Are you still awake?" Nicole said, rolling over.

I didn't answer, pretending to be asleep.

But I didn't sleep. Not a wink.

***

Casey was back in my office a week later, this time in maroon scrubs and white sneakers. She was going to work after our morning counseling session and had on a bunch of jewelry - lots of silver rings and bracelets. The dangle teardrop earrings she was wearing were hidden by her shoulder length straight red hair, which was messy, like she'd just worked out or even had sex. It was possible she'd done either one. She self-consciously put it back in a ponytail, and I noticed her black eyeliner was smudged, and her mouth looked raw, like she'd been kissing. She had pink lipstick on her front teeth, too.