Monday, December 31, 2007

Exercise 4: Life timeline.

The goal of this exercise is to translate the material from the sex history into a visual format to help understand how your sexual behaviors have occurred across time. Complete the following exercise attempting to be as thorough as possible. You might need to devise a code to fit everything into the timeline. (It might also be helpful to tape a few pieces of paper together to make a larger piece.) Across the left hand edge of the page, draw a vertical line. The vertical line should be numbered –5 to +5. At the center of the vertical line, draw a horizontal line going the length of the page. The horizontal line reflects your age across time. Take the responses to the sex history questions and list the events along the horizontal line roughly reflecting your age at the time of the event. In addition to the behaviors identified in your sexual history, plot the following life events on the time line.

1) Meeting a best friend.

2) Having a crush.

3) Age when you hit puberty.

4) Your first time of masturbation.

5) Age when you can first remember being attracted to another person

6) Your first kiss/ first date

7) Age of your first orgasm.

8) Age when you first had sex (however you define that)

a. With a girl

b. With a guy

9) Age when you had your first relationship

10) Age at relationship changes (new relationship, divorce, break-up, marriage)

11) Age at life changes (move, new job, sobriety, first child, illness, death of a loved one).

12) Any other relevant critical incidents in your life. A critical incident is any event, “large” or “small” that has meaning in your life. An example might be when you self-identified as “gay.”

13) With additional color pens or pencils, track other relevant behaviors. This might include tracking spending behaviors, drug or alcohol behaviors, gambling, etc. A later assignment will ask you to reflect on other behaviors that correlate to your sexual behavior.

14) Next, with additional color pens or pencils track additional life events such as depression/mood, stress, marital satisfaction, job satisfaction, or other important events in your life. Below is a simplified example to illustrate how to complete a timeline.

By charting these events, it may be possible to discover simple and/or complex patterns to an individual’s sexual behavior. In the example below, I graphed mood, anxiety, job satisfaction and sexual satisfaction. Reviewing the chart, there appears to be a relationship between mood and frequency of sexual functioning. While it is possible to see a relationship, it is not possible to determine cause and effect. In this case, the mood may lead to sexual acting out; alternatively, sexual acting might be an attempt to feel better; another alternative is that the person feels depressed because of the sexual acting out. Because of the graph, we get a sense of the relationship. Therapy is a process of exploring and understanding the relationship.

Friday, December 14, 2007

Exercise 3: Compulsive "Acting Out" Cycle

The acting out cycle is a framework to explain how people “act out” their compulsive behaviors. The entire treatment is connected to this cycle. The key to changing the cycle is first recognizing the feeling triggers, high risk settings, and thinking,” identifying “active and passive” ways of acting out, and the perceived payoffs. We will review each of these concepts in subsequent exercises. But for now, a brief review is provided to help you develop an initial understanding.

Expanding upon the cycle:


Set ups are often easily recognized. Most people who struggle with sexual compulsivity can identify various feelings before they act out. For the sake of simplicity, I have reduced the types of set-ups to three: Emotional Triggers, Thinking Errors, and High Risk Situations. An example of a feeling trigger can help explain the concept. A person feels depressed, so he or she makes a call to the phone line which leads to a sexual encounter. The feeling identified in this example, depression, precedes the acting out incident. In the same example, a thinking error that might be present includes the thought “I’ll only make a phone call, it isn’t a big deal. I won’t hook-up afterwards.” The high risk situation in the example includes making a call to the phone line. As you move through the treatment process, you will start to identify additional setups that increase the risk for acting out. In the end, you’ll probably be able to identify ten to fifteen setups of each type.

Acting Out

The acting out phase of the cycle is often recognized as the sexual behavior (for example, I had sex with this person; I watched some porn). What you will recognize is that the sexual behavior is only one type of acting out. In the field of chemical addition, there is a term used called “cross-addiction.” I have worked with clients who have stopped their chemical use, but then their sexual behavior gets out of control. Once both the sexual behavior and chemical use are under control, it isn’t surprising to see another issue develop such as eating disorders, compulsive spending, and or gambling behaviors. The key to understanding the cycle is that the sexual behavior is only an expression of the cycle; you need to gain a better understanding of all the different ways you may act out. In recognizing the range of behaviors, you can then address the real problem: the cycle and avoid a band-aid approach to sexual health. As we move through the process, you will discover passive ways of acting out are as important as active ways of acting out. For example, I’ve worked with clients who will withdraw from conflict because of fear. This will result in the person feeling resentful which is a set up for explosive anger (another type of acting out).

Pay offs/Costs

Pay offs refer to the perceived outcome of the behavior. In the example above, the perceived pay off was a relief from the depression. As you can probably recognize, the payoff is usually temporary. Sometimes the perceived payoff leads to the cycle starting all over again. It is important to think strategically in this area. You might not always recognize other payoffs. Yes, the sexual behavior might be pleasurable, but another payoff might be avoiding the fear of being hurt in a relationship, so choosing a casual encounter is also “safe.” Costs are more easily recognized. In behavioral terms, we identify these as “consequences, ” examples include my partner is angry about my behavior; I was arrested; I got drunk.

Relationship between the components.

If you examine the arrows in the cycle, you will see that each is double pointed. The cycle is dynamic, meaning it is always shifting, moving and adapting. The cycle provides feedback to the individual, and the individual adapts as necessary to continue the cycle. This relationship will be reviewed throughout the exercises as well. An acting out encounter may have a consequence (cost) that sets the person up to act out again. Treatment involves working through this cycle and addressing all aspects.

Friday, December 7, 2007

Creating Sexual Health

Integrated into my treatment philosophy is an explicit goal of helping the client clarify his or her appropriate sexual behaviors. Toward this goal, it is important to understand what sexual health is. The definition of sexual health that I liked the most was published by the World Health Organization. They define sexual health as a . . .

“. . . state of physical, emotional, mental and social well-being related to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled” (WHO, 2002).

The definition is very complex and represents nearly 30 years of scholarship and development.(For those desiring an understanding o f the history of defining sexual health please see one of the papers that came out of my dissertation [ Edwards & Coleman, 2004]). Sexual health is more a process than a dichotomy answered by a yes or no. As treatment continues, the key is to help the client develop and improve their sexual health. I found another article helpful in framing the process toward sexual health. Robinson et al (2002), provides a model which consists of 10 components which are briefly summarized.

The Ten Components of the Sexual Health Model.

1. Talking About Sex is a cornerstone of the Sexual Health Model. This includes talking about one’s own sexual values, preferences, attractions, history, and behaviors. As you can see, the first exercise is about evaluating your ability to talk about sex.

2. Culture and Sexual Identity are instrumental to understanding one’s sense of sexual self. It is important that individuals examine the impact of their particular cultural heritage on their sexual identities, attitudes, behaviors, and health.

3. Sexual Anatomy and Functioning assumes a basic knowledge, understanding, and acceptance of one’s sexual anatomy, sexual response, and sexual functioning. Sexual health includes freedom from sexual dysfunction and other sexual problems.

4. Sexual Health Care and Safer Sex covers a broad perspective encompasses knowing one’s body, regular self-exams and responding to physical changes with appropriate medical intervention. Examination of one’s safer sex behaviors is critical.

5. Challenges and Barriers to Sexual Health include the major areas of as sexual abuse, substance abuse and compulsive sexual behavior. Other challenges might include sex work, harassment, and discrimination. Treatment must address these areas.

6. Body Image requires challenging the notion of one narrow standard of beauty and encouraging self-acceptance. Sexual health requires a development of a realistic positive body image.

7. Masturbation and Fantasy can be a healthy expression of sexuality. It is important for individuals to clarify their values on masturbation and fantasy. Too often, masturbation and fantasy are linked with shame because of the historical myths associated with sin, illness, and immaturity.

8. Positive Sexuality recognizes that all human beings need to explore their sexuality in order to develop and nurture who they are within a positive and self-affirming environment. Positive sexuality includes appropriate experimentation, sensuality, sexual competence developed through the ability to get and give sexual pleasure and setting sexual boundaries.

9. Intimacy and Relationships. Intimacy can take many forms and is a universal need that people meet through relationships. Sexual health requires knowing which intimacy needs are important for the individual and appropriate ways to meet these needs.

10. Spirituality and sexual health assumes congruence between one’s ethical, spiritual, and moral beliefs and one’s sexual behaviors. Spirituality may or may not include identification with formal religions, but always addresses moral and ethical concerns and deeper values in order to integrate a person’s sexual and spiritual selves.

The exercises and assignments in this blog and in my treatment work are designed to help an individual in their process toward improved sexual health as presented in the sexual health model. The process is extensive, requires significant work and effort. In my opinion, sexual health can be reduced to a process of integrity toward one’s behaviors and one’s values. Hence, the previous conversation on integrity takes one a new level of importance. I cannot define for the individual what is “sexual health.” Only the individual can do so. My commitment is to you express your sexuality with integrity.


Edwards, W. M., & Coleman E. (2004). Defining sexual health: A descriptive overview. Archives of Sexual Behavior, 33(3), 189-195.

Robinson, B. E., Uhl G., Miner, M., Bockting, W. O., Scheltema, K. E., Rosser, B. R. S., & Westover, B. (2002). Evaluation of a sexual health approach to prevent HIV among low income, urban, primarily African American women: Results of a randomized controlled trial. AIDS Education and Prevention, 14(Suppl. A), 81-96.

World Health Organization (2002). Gender and Reproductive Rights, Glossary, Sexual Health,

Friday, November 30, 2007

A program of integrity versus a rigorous program.

A recent phone call prompted this post. The end result of the conversation was feedback that my program wasn’t “rigorous enough.” When I asked how things might be different, the individual wasn’t able to answer. When I reflect on the question and my response, I came to a clarifying insight. I affirm that my approach to treatment is not “rigorous.” Rather, my treatment approach emphasizes integrity.

Let’s expand on the two terms, rigorous and integrity. Merriam -Webster defines rigorous as: “1): harsh inflexibility in opinion, temper, or judgment: severity (2): the quality of being unyielding or inflexible: strictness (3): severity of life: austerity b: an act or instance of strictness, severity, or cruelty.” Explicit in this definition are the concepts of cruelty, inflexibility, and emphasis on rules and procedures.

Applying this definition to a treatment program, it is easy to imagine how many people desire the clinician to be in charge. I can’t tell you how many times that I’ve been asked “Tell me what to do.” “Is this OK?” or “what should be my bottom line behavior?” As a clinician I will provide feedback and suggestions, but I impose very few behavioral restrictions. When I do, the restrictions are usually around legal, ethical or health consequences. I might say “Remember Sen. Larry Craig? Engaging in public sex like you just described probably isn’t helpful.” Or, “Using the work computer to look at porn will get you fired.” And as a final example, “Unsafe sex puts you at risk.” To fall into the trap of “rigorous treatment,” in my opinion, sets up the therapist as the external control which is bound to fail. In motivational psychology, a long term consequence of external control is a decrease in compliance to the external limits. Slowly, resentment builds as the individual “fights” with the external limits. Eventually a total break might occur where the client’s resistance causes a rupture in the therapeutic relationship. One of my critiques of the “sexual addiction” approach is the risk of imposing an external code to create sobriety through rigorous compliance. This code is usually reflects narrow Christian values. Simply complete a web search and you’ll find many therapists treating sexual addiction using a 12-step approach with a Christian evangelical approach. In the long run, it is my opinion that this treatment approach will fail.

Instead, I emphasize integrity in my treatment approach. Merriam-Webster defines integrity at “1: firm adherence to a code of especially moral or artistic values: incorruptibility; 2: an unimpaired condition: soundness; 3: the quality or state of being complete or undivided.” Implicit in this definition are the ideas of wholeness, completeness, and unity. The approach also implies an internal local of control. Research in motivational psychology has repeatedly demonstrated that individual’s will create profound possibilities when internally motivated. When a person is internally motivated, they will do things not thought possible; they will run marathons for example because they want to make a difference in the world. Think for a moment of someone who has inspired you; their source of motivation was probably internally focused. My treatment approach is designed to help the individual create integrity in their life. The goal is to help identify behaviors, attitudes and goals that lead to wholeness, completeness and unity. This approach, however, is more work and intensive than simply following a list of rules. It also requires some trial and error which results in reassessment of the internal purpose. Following this approach, a client who has created an internal moral code of sexual health will be happier, more effective and ultimately “whole.” This is what I create in my treatment approach.

Furthermore, my commitment is to provide my services with integrity. My internal purpose evokes from me a level of interest in your progress that goes beyond the therapeutic hour. I try to help you develop a parallel internal purpose as defined by you. My role is to be a coach, advisor, teacher, and supporter. And it requires direct honest feedback which may sometimes feel harsh. But, paradoxically, you’ll be amazed at how often I’m “thanked” for being honest with my clients. In the end, my treatment approach requires from you a transformation versus a compliance with a set of rules. And in this transformation, unlimited possibilities are possible.


Merriam-Webster Dictionary retrieved from

Visual Thesaurus retrieved from

Saturday, November 24, 2007

Exercise 2: Completing a Sex History.

A natural progression from talking about sex is the exercise of talking about your sex history. As you begin the process of addressing sexual compulsivity, it is important to accurately describe your past sexual behavior. You cannot treat that which is not identified. The assignment is to complete the questions as thoroughly as possible. I often suggest that see this document as a "living document" which means it might be helpful to periodically return to the assignment and add material as you remember pieces of your history.

As you work through the sex history, it is important to be as honest and thorough as possible. At first, you may not want to put everything on paper or answer honestly because of what others might think. However, when you are open and honest, in the long run, you have a better sense of what needs to be dealt with in your treatment process.

When you have completed the inventory, please share the responses with another person. At this time, it not recommended to disclose this information to your primary partner (that disclosure will happen near the end of stage 2 and the beginning of stage 3). It is also recommended that the persons with whom you disclose the information be trustworthy and non-judgmental. Typically these individuals are therapists, sponsors, or members of a group process.

1) At what age did you first masturbate?
2) How did you learn about masturbation?
3) What messages did you hear about masturbation while growing up?
4) What were your beliefs and feelings about masturbation while growing up?
5) What are your beliefs about masturbating today?
6) How often do you masturbate currently?
7) When was the last time you masturbated?
8) What thoughts did you have when you last masturbated?
9) Where have you masturbated besides in your home? Describe the circumstances.
10) When you masturbate, what objects have you used to enhance your level of sexual arousal (e.g. items of clothing, vibrators, magazines, “sexual toys”, items to inflict pain). Describe the items and when you began to use them for sexual stimulation.

1) Describe your three most arousing current sexual fantasies?
a. How do you feel about these fantasies?
2) What messages and beliefs did you hear about fantasy?
3) What beliefs do you have about fantasy today?
4) Have you ever masturbated to sexual fantasies of rape? If so, describe the fantasy (including your relationship to the victim, the frequency of the fantasy, and the length of time since the last rape fantasy).

Sexual Behavior
1) At what age did you first have sexual intercourse?
2) How old was your partner?
3) How did you feel about the experience?
4) How many sexual partners have you had?
a. Fill out a table including each partner to the best of your ability. For example

Your age

Partners Age

Type of Sexual Contact

Length of Relationship



Vaginal Sex, Oral Sex

Dated for 12 months



Vaginal Sex

1 encounter

b. If the number of partners is too high to count, complete the table by examining periods of your life and estimating the number of contacts. Pick periods that make sense to you. For example,
i. Upto Age 14 (pre-adolescence), number of partners______
ii. Age 15-18, Number of partners _________
iii. College, age 19-24, Number of partners ________
iv. First Job, Number of partners ________
v. First Relationship Number of partners ________
vi. Divorce and/or end of first relationship, Number of partners ________
vii. Lived at a particularly address, city, Number of partners ________
c. Describe what behaviors occurred (be explicit and thorough)
(for example, anal sex, vaginal sex, mutual masturbation, kissing, touching, etc)
d. What was the length of the relationship?
(one night stand, casual, dating a few months or longer relationship, partnership,
e. What percentage would you estimate were “one night stands”?
f. How many sexual partners have you had of the same sex as yourself?
i. How did you feel about it then
ii. How do you feel about it now?
g. How many of these sexual encounters occurred while using drugs and/or alcohol? Describe the circumstances.
5) How many times have you had a sexual affair while you were married or while in a committed relationship with someone? Describe the circumstances.
6) Describe the nature of any sexual contacts or behaviors between members of your family.

Dating Behavior
1) At what age did you begin to date or go out with girls/boys your own age?
2) Describe your level of self confidence regarding dating.
3) How comfortable did you feel?
4) Did you think you were attractive to girls/boys?
5) Did your self esteem improve or decrease as you dated more frequently?

Other patterns of sexual behavior
1) How many times have you paid money for sex or traded drugs for sex?
2) If you used prostitutes in the past, describe the types of sexual activities you engaged in.
3) Have you engaged in prostitution yourself?
4) How many times have you had sexual touch with an animal? Describe the circumstances.
5) How many times have you exposed your genitals to someone you did not know or to someone without their consent? Describe the circumstances.
6) How many times have you spied or peeked at someone in order to see if they are undressing or being sexual? Describe the circumstances.
7) Describe the types of sexual magazines and sexual movies you view for sexual stimulation.
8) How many times have you used threats of violence, physical force, or any weapon to make someone perform a sexual act (other than during your current offense)? Describe the circumstances.
9) How many times have you participated in consensual use of restraints or bondage? Describe the circumstances.
10) How many times have you ever participated in group sex? Describe the circumstances.
11) What other alternative or kinky behaviors might you have participated in?

1) How many times have you made sexual phone calls or used a 1-900 sex line? Describe the circumstances.
2) How many times have you used the internet to meet sexual partners? Describe the circumstances.
3) How many times have you used the internet for “virtual” sex.
4) How many times have you searched the internet for pornography or pictures? Describe the circumstances.
5) How many pictures/videos have you downloaded?
6) Have you downloaded pictures of explicit child sexual material? If so, describe the circumstances.

Health Concerns
1) What physical problems have you experienced which effect your ability to be sexual (such as difficulties achieving or maintaining erections, difficulties having orgasms, a lack of interest in sex, difficulties in delaying ejaculation)? Describe the circumstances.
2) Describe the sexually transmitted illnesses you have had. Describe the circumstances how this illness was transmitted.

1) When were you ever sexually touched or forced to engage in sexual behavior against your will as a child? Describe the circumstances.
2) When were you ever sexually touched or forced to engage in sexual behavior against your will as an adult? Describe the circumstances.

1) Describe any sexual contact you have had with children while you have been an adult.
2) Describe the content of sexually explicit pictures of children you have seen or possessed. How often have you viewed these pictures?
3) Have you masturbated to fantasies of children? If so, describe the details.

1) Describe any legal consequences of your sexual behavior.
2) Describe the frequency of legal consequences.

1) Describe any sexual behaviors or practices which were not addressed in the above questions. 2) Which three questions above which were the most difficult to answer.
a. Why did you select these three questions
b. What made them so difficult to answer?

Thursday, November 15, 2007

Exercise 1: Talking About Sex

To start addressing questions of sexual compulsivity, it is important to reflect on your ability to talk about sex. The goal for this exercise is to 1) To assess your ability talk about sex and sexuality with others. and 2) To identify people with whom you can talk about sex.

As you start this process, it is important to examine how comfortable are you talking about your sexuality and sexual behavior. I am confident that as you progress through the work, your comfort level will increase. It is not uncommon, however, to be nervous, embarrassed, feel guilt and/or shame about the information to be reviewed.

Exercise 1

Answer the following questions.

YES/NO 1) I avoid talking about sex.

YES/NO 2) I talk about my sexuality with my friend(s).

YES/NO 3) I find many sexual matters too upsetting to talk about. (R)

YES/NO 4) I talk about my sexuality with my sexual partner(s).

YES/NO 5) I talk about my sexual feelings.

YES/NO 6) I usually feel comfortable discussing my sexual values.

YES/NO 7) I usually feel comfortable discussing topics of a sexual nature.

YES/NO 8) In general, I usually feel comfortable discussing my sexuality. (R)

YES/NO 9) Talking about sex is usually a positive experience.

YES/NO 10) It bothers me to talk about sex. (R)

YES/NO 11) I usually feel comfortable discussing my sexual behavior.

YES/NO 12) There will be negative consequences if I talk about sex. (R)

Score 1 point for each yes (# 1, 2, 4-7, 9, 11)

Score 1 point for each no (# 3, 8, 9, 12)

More than 8 points, suggests a difficulty talking about sex.

Exercise #2.

1) Reflect on the above questions, explain your responses.

2) Name three people you could start talking to about sexuality. This could be pastor, friends, colleagues, sponsor, therapist, partner/spouse, etc.

3) Write one paragraph summarizing what you would like to share with each of the individuals at this time regarding your questions of sexual compulsivity. Share as appropriate.

Sunday, November 11, 2007

What is sexual compulsivity?

A definition and universal term is perhaps the most difficult dilemma in the field of sexual compulsivity. How do we define a concept that has been widely misused and overused? Simply looking at the concept, there are multiple terms to describe the same phenomenon including sexual compulsivity and sexual addiction. These terms are the most prevalent; however additional terms that are used include sexual impulsivity, sexual obsession, sexual anorexia, sexual compulsion, out of control sexual behavior, sexaholism and, finally but certainly not the last, love addiction. As you can see, the field itself is far in agreement on a universally accepted term. And, each term reflects a different theoretical foundation and treatment approach. While the differences are varied, nevertheless, there is perhaps more overlap when talking about the concept, even if there is not agreement on the terminology. Generally, I prefer the term sexual compulsivity. It is the term that I use in my work. Part of the rationale of my choice of the term reflects a behavioral model over an addiction model.

A large number of resources ranging from websites, journal articles to self-help books discussing sexual compulsivity exist. Simply complete a web search, and the number of hits is about 2 million. My goal here is not to replicate what is already available. In this venue, I’ve chosen to summarize and simplify the definition. Remember, my goal is not a theoretical treatise, or academic journal article. My goal is to identify a definition that works in the majority of circumstances to provide a resource for individuals struggling with sexual compulsivity.

The definition of sexual compulsivity that I use has two parts. The first part is a subjective level. On some level, the individual recognizes that his/her sexual behavior interferes with his/her life. The second level is an objective level. The interfering sexual behaviors sometimes will breach an external boundary with consequences.

Each part requires additional exploration. On the first part, the individual recognizes that their sexual behavior is a problem. Sexual compulsivity is when as any sexual behavior or thought violates your personal values and boundaries. These behaviors often lead to negative feelings of guilt, shame, and self-recrimination. In psychology we call this egodystonic. In my treatment approach, there is a failure of integrity between what they say they want and what they do. The vast majority of people seeking help realize they need help. Because of the recognition by the individual that he or she has a problem, it is usually sufficient to focus on the first part of the definition in my work.

The second part of the definition allows external feedback to the person regarding the impact of their sexual behavior on others. In some cases this can be a legal consequence such as an arrest. In other cases, the behaviors create financial consequences. And yet in some other cases, relationships end because of the violation of the boundaries. This objective part of the definition may not always be present, but is useful when the level of denial regarding the individual’s internal awareness is so great that they fail to recognize the impact of the behavior.

Two of the dilemmas with this definition are what some critics of the field say is sex negativity, and labeling of many types of sexual expression as sexual compulsivity as a form of social control. A classic example is how homosexuality was previously illegal or an illness; now control is exerted by labeling homosexuality a sin. I am aware of these concerns. In later posts, I will write about sexual positive and sexual health.

What behavior is considered compulsive is hard to define. Often the answer is “depends.” Often, the answer will depend on the presence of consequences, your values, your agreements with others (i.e., marriage/partnership). The basic premise I have is that YOU define healthy and unhealthy behaviors in relationship to others. At the same time, there are behaviors that automatically raise questions. For example, researchers in the field suggest that spending 11 or more hours a week checking out Internet Pornography is one threshold of Internet Sexual Compulsivity. This number, however, does not answer the question with any sense of finality. As you work through the workbook, you may find that the same behavior may or not be compulsive depending on the day, your mood, and other circumstances.

Just to note, sexual compulsivity is not the same as sexual promiscuity or pedophilia. Sexual compulsivity also can occur in the absence of sexual behavior (obsessive thoughts, fear of sex). Sexual compulsivity is also not the same as pedophilia (defined as an attraction to children). And while they may sometimes (rarely!) overlap, the two issues are separate therapeutic concerns.

In the end, the goal of this post was to help people recognize the concept of sexual compulsivity. The key component is the individual’s recognition that their sexual behavior creates a problem in their life. The key to treatment, however, requires additional information as to why, what, who, when, and where the problem lies.

Wednesday, October 31, 2007

Partners of individuals struggling with sexual compulsivity

As a new blog, it is important to recognize a gift when something occurs. Today, I received such a gift via a phone call from a woman who is the partner of a person with sexual compulsivity. (The gift is that her struggle became today’s topic. As a resource, my goal is to respond to particular needs. Feel free to suggest topics and review the list of upcoming topics.) “Jill” (not her real name) is struggling with a partner in denial about his behavior. She is frustrated, angry and confused about what to do. In our conversation, my assessment is that she came across as assertive in her search for information on how she can cope with his behavior. To a degree, she knows what she wants and needs to do. Her goal is find information in her journey to facilitate the process and avoid obstacles. Unfortunately, she couldn’t find much information.

After completing a search, I agree with Jill that there is very little information. A few books exist, but not much is written about it from a scholarly point of view. One author that I found (Tripodi) affirms that little information exists. Tripodi’s experience is a good place to start understanding the experience of the individual whose partner is caught in the compulsive cycle. I summarize her findings here.

Tripodi highlights that it is typical to experience feelings of despair, hopelessness, confusion anger and sadness. The powerlessness that comes with not knowing what to do and how to get your partner to stop the behaviors is to be expected. Various forms of denial may occur. These forms may be blaming yourself, turning the other cheek, buying into the partner’s commitment to change by “giving him one more chance.” Eventually, the denial strategies fail, and the individual is faced with responding to the partner’s behavior. In some cases, the individual isn’t in denial; rather, he or she simply doesn’t know until some type of disclosure occurs by the partner that there is a pattern of compulsive behavior. I do disagree with Tripodi’s statement that the underlying theme in “all cases” (yes, her word, page 5) is the lack of a developed self leads to the individual undermining and second guessing themselves. In my opinion, this is the same as blaming the rape victim for being raped. In many, if not most cases, this theme might be present; in other cases it is absent particularly when the individual is unaware of the compulsive behavior and disclosure occurs unexpectedly. One such example is when the individual received a positive result for an HIV/STD test which requires a follow-up with the partner who then discloses a history and pattern of compulsive behavior.

While much of the blog will focus on treatment for the individual with sexual compulsivity, this entry is to address treatment issues for the partner. The following issues need to be addressed in your support network. Many times, they will need to be addressed more than once as future disclosures occur or choices made in response to the behaviors. I like Tripodi’s paradigm of early, middle and final phases of treatment. They parallel the stages of treatment that I use. I provide a summary of the issues to be addressed in treatment for the spouse.
  1. Need for support. This can be through professional help, peer network (groups), family and spiritual. Feelings of shock, confusion, anger, hurt, sadness, depression and grief are but a few of the emotions that an individual will face.
  2. Need for information. The phone call from Jill reflects this need. She was seeking information on where to get support, who and what she needs to do to take care of herself, etc. What she and later I discovered, is there isn’t a lot of information available. Increasing familiarity with the language is also part of this goal. Those in the 12-step movement and therapists often use a jargon for short hand communication. Learning what these terms mean is important.
  3. Medical Health. When a partner has multiple sexual contacts, the individual is at increased risk for HIV/STIs. Tripodi recommends that the individual seek medical attention to assess any possible problems. It is my recommendation that you be completely open and honest about the purpose of the visit with your health care provider. Some providers will assume that since you are in a relationship, you’re not at risk. You will need to be explicit and say “I found out my partner has multiple sex partners and I’m worried about being infected with a sexually transmitted illness (STI).”
  4. Safety for Family. Sexual compulsivity is not the same as pedophilia. However, as Tripodi states, family members may have access to pornography. Setting boundaries to maintain safety of others is important.
  5. Triage. Identify what needs to be done today, and what can be done in one month, three months, or 1 year. Unfortunately, no guidelines are availabe. Tripodi identified how individuals may be pressured to leave the relationship. If possible, I recommend that you wait a period of time (the length of which, you decide) where you focus on the immediate concerns. This suggestion, however, is mute if your safety is at immediate risk.
  6. Focus on the self. As you move away from crisis/shock, it is important to stay focused on your emotional and physical health. As you cope with the partner’s compulsive behavior, you need to identify what you need to do for your self-care. This includes addressing the shadow aspects of your personality. It also includes clarifying what you need and want in a relationship and an honest assessment of where the current relationship is going. Some relationships can be saved, some should end. This is a chance for you to clarify your boundaries and develop the skills to enforce those boundaries.
  7. Life Purpose. Near the end of the treatment, it is important for you to step back and review where/how/what you want in life. This may mean developing the skills for new employment, coping with divorce, or reestablishing intimacy with your partner. Each goal will require different interventions.

The seven areas are great places to start. I’ve included additional references below to also help you in your journey. Good luck to Jill and to others in a similar spot.


Academic Resources:

Tripodi, C. (2006) Long Term Treatment of Partners of Sex Addicts: A Multi-Phase Approach. Sexual Addiction & Compulsivity, 13, 269-288.

Book Resources:

Schneider, J. (2005) Back From Betrayal, Third Edition, Chapin

Mellody, P., Wells-Miller, A., Miller, J. Keith (2003) Facing Co Dependency. HarperOne

Mellody, P., Wells-Miller, A., Miller, J. Keith (2003) Facing Love Addiction. HarperOne

Web Resources

Sex Addicts Recovery Resources

Support Groups

Co-Sex Addicts Anonymous (COSA)

Tuesday, October 30, 2007

Sexual Compulsivity Treatment Approach

The approach I use in treating sexual compulsivity is to blend aspects of cognitive-behavioral psychology, humanistic psychology, and positive psychology. What this means in non-technical terms is that I attempt to help you increase your awareness of your thoughts and behaviors, within a supportive environment to help you create a better life for yourself. In light of this integrated treatment approach, I have developed a number of assignments based on clinical experience and education which are designed to address issues or topics relevant to sexual compulsivity.

Generally, the assignments have the following goals:
By understanding your “acting out cycle” by knowing your primary high risk situations, feeling triggers and thinking errors you can reduce the raw number of compulsive behaviors. The assignments are designed to explain the concepts and apply them to your treatment process. In addition to eliminating the unhealthy behaviors, the assignments will also address related topics that may be relevant to your sexually compulsive patterns.

2) Helping you develop healthy sexual behaviors.

Eliminating unhealthy behaviors simply creates a void. To maintain long term health, the void needs to be replaced by healthy sexuality. This assignments will help you understand yourself better (self-knowledge), provide for a breadth of information that facilitates healthy sexually choices, facilitate your journey to define appropriate sexual behaviors, and review any possible barriers that get in the way of living a life you love. As such, this goal is to address issues beyond simple sexual behavior.

Structure of the assignments

The assignments are structured into three stages. Within each stag are exercises designed to help increase your ability to cope with sexual compulsivity. The assignments attempt to provide clear-cut tasks to help the individual address sexual compulsivity. Some of the topics are more important and should be completed by all individuals. These have been marked as “primary” exercises. As you move through the assignments, some may not apply to you. The process is designed to be adapted to your particular needs: complete only those assignments that are necessary for you. And I encourage you to review each assignment and not simply dismiss the topic. I’ve learned that many people can learn more about themselves when they ask “how does his topic apply” versus “does this topic apply.” As a note of caution, you may experience personal distress while working on the assignments. This is typical in any personal growth process. It is strongly recommended that you have a support system to facilitate your work. This support can include a therapist, sponsor, or self-help group.

The structure of the process takes the individual through the following three stages:

Problem Identification

During this stage, you will have opportunities to examine your sexual behaviors and assess the level of compulsiveness. You will complete a number of assignments examining your sexual history, and your acting out cycle. Based on your findings, you will be able to identify the major topics that will need to be addressed in your journey toward improved sexual health.

Primary Treatment

Once you have identified the major issues during stage 1, the second stage of treatment helps you begin the work on the issues by providing assignments and resources for the most frequently identified issues. Not every issue you identified may be included; you may need to address additional issues. And, in reviewing the topics, you may identify additional concerns that contributed to your acting out cycle. Not all of the issues will apply but it is recommended give serious consideration to each topic.

Prevention Planning

The third stage of treatment attempts to stabilize the growth and movement toward sexual health that occurs in stage two. Stage thee attempts to help you reach out to others for support, encouragement and accountability. You are also encouraged to consider how you would live a life you love and the impact of sexual health in personal self-fulfillment. The goal is to develop plans to move in that direction.

The Importance and Limits of Confidentiality and Risk of Disclosure

Trust is a major component of counseling. In my opinion, trust builds safety and safety can lead to tremendous therapeutic change. This trust is facilitated by knowing that any information you share will not be passed onto other people. In any therapeutic relationship, confidentiality is the privilege the client has that limits what a professional can disclose any of the information about the client to others. Depending on where you live, however, any professional you work with has limits to this privilege. Most often these limits are designed to facilitate safety in the broad sense of the term. Most often the limits to confidentiality require the professional to report any suspected abuse to a child or vulnerable adult; significant and real potential harm to yourself (statements such as I’m going to kill myself); significant and real potential harm to another person (I’m going to kill that person); or when a court order requires the release of information.

As you complete the assignments, it is important to be open and honest about your past and present behaviors. While it is important for disclosure to occur, it is important for disclosure to occur in a prudent manner. Be careful when making disclosures of sexual behavior. Seriously consider if your disclosure of information would trigger a mandatory report as required by the state and local laws in your residence. There may be a risk of legal consequences if some of your sexual behaviors include illegal behaviors. One way this can be done is to be specific about behaviors, but do not provide any identifiable information. For example, you might want to say “Sexual partner #1” versus giving specific identifiable information. We will address the issue of disclosure to partners in a particular assignment. My bias is that disclosure should occur; the question is when and how which is not the focus at this point. It is worth repeating, the goal is to be as honest to yourself and your therapist/treatment team as possible.

Sunday, October 28, 2007

Welcome to the Sexual Health Institute

Welcome to the new blog for the Sexual Health Institute. You can check out the Sexual Health Institute at

In starting this blog, I think it is important to explain why the time is right. There are three primary goals I would like to achieve

A) To promote sexual health
B) To provide a resource for Sexual Addiction/Compulsivity
C) To provide on-line support for individuals struggling with Sexual Health Issues.

My plan is to highlight recent research and clinical findings. In addition, various activities or worksheets will periodically be made available. I'd encourage you to add your responses to the material or to the activities. The goal is to provide you a chance to share your struggles and to listen to the struggles of others in a safe environment.

The blog is NOT a replacement for therapy. No theraputic relationship is envisioned. You may use any material for personal use only. If you use the material, it is recommended that you work with a 12-step group, professional or other treatment protocol as well.

Please feel free to contact me if you have questions, or post a response as well