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Can Tiger be cured of his philandering ways?

Tiger Woods and his wife Elin Nordegren walk down the catwalk during the Ryder Cup Gala Dinner at Citywest Hotel and Golf Resort on September 20, 2006 in Dublin, Ireland.

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Can Tiger be cured of his philandering ways?

More than a month after his astounding fall from grace, the golf star has reportedly checked in to sex rehab. Paparazzi descended on the small town of Hattiesburg, Miss., this week where Tiger Woods is said to be seeking treatment for a sex addiction at the Pine Grove Behavioral Health and Addiction Services.

While we're left to scrutinize grainy photos of a man deemed to be Tiger trolling the grounds of Pine Grove and snapshots of builders adding metres to the facility's wall, the real puzzler is this: What exactly goes on in sex rehab? Here's a breakdown:

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How long is a typical stay in sex rehab?

Therapists and physicians who recognize the disorder say sex addicts definitely need more than 30 days to "get sober." People seriously hooked on sex face the same challenges as those who abuse drugs, alcohol and gambling, said John Pitt, director of Asklepion Toronto, a sex therapy clinic.

"It's all about trying to sort of soothe or avoid emotional dynamics inside the person," he says. "For some reason, some people choose sexual behaviour, some choose alcohol."

Some stays are much longer. Pine Grove's "intensive program" lasts six weeks, according to its website.

What happens in sex rehab?

Addicts are stripped of all control when they enter sex rehab, barred from sexual activity and anything that might turn them on.

"Treatment of any addiction begins with abstinence," says Graeme Cunningham, director of the addiction division at Homewood Health Centre in Guelph, Ont. "Three months, 90 days of complete abstinence of sexual activity," he says, a pact that goes far beyond the standard one-month stay in rehab.

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A typical day in an inpatient sex clinic starts at 6:30 a.m. with exercise, usually a brisk walk around the facility, Dr. Cunningham says.

The subsequent hours are spent talking about sex - patients learn how to banish sexual fantasies and realize that their actions are hurting others, he says. In groups of eight to 10 people, addicts will ask and answer questions such as "I thought about calling and paying for sex last night. What do you guys think about it?" Dr. Cunningham says.

"I teach my addicts: You're not responsible for the first thought, but you are responsible for the action afterwards."

Like a drug user coming down from a high with no powder or pills in sight, sex addicts go through slow and painful withdrawal, Dr. Cunningham says. "Agitation, depression, restlessness, anger, insomnia. There are a lot of emotional feelings and behaviours, like jonesing," he says.

Coffee, cigarettes, the Internet - anything addictive is strictly off-limits. TV watching is monitored and visits from family are usually verboten. There's a lot of trust-building too - with others and with themselves, he says.

Tiger Woods is reportedly expressing remorse for his sexual misdemeanours in empathy letters to his wife Elin Nordegren. The Pine Grove program also includes yoga, relapse prevention counselling and shame reduction work.

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How is abstinence enforced?

Rehab centre staff do not peek in on patients to check whether they're masturbating. If a patient stumbles or relapses while in treatment, they need to own up to it in group therapy, and the therapy will intensify after that, he says.

The trick is teaching the sex addict how to be intimate in a healthy way after checking out, Mr. Pitt says.

"Unlike alcohol, we need sexuality in order to be healthy. While an alcoholic would need to move toward a life without alcohol, a sex addict would need to be moving toward healthy sexuality," he says.

Patients are finally ready to go when they recognize their problem, are able to follow the tenets of the 12 steps and can stick to a 90-day celibacy plan, Dr. Cunningham says.

Does sex rehab work?

Some physicians, such as Paul Fedoroff, don't think total abstinence is a cure. The co-director of the Sexual Behaviours Clinic at the Royal Ottawa Mental Health Centre says he once saw a patient who claimed to have sex 10 or more times a day.

After talking to the patient, the doctor linked his sexual behaviour to his frustration from being unemployed, and helped him find a job. The behaviour disappeared.

"It's kind of like a signal. ... Sex is never the problem. It's always the other problem coming out of that" that needs to be addressed, Dr. Fedoroff says.

Interviews for this story first appeared in a Globe and Mail article on sex rehab published in October 2008.

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